个体化相位-振幅耦合经颅交流电刺激对耳鸣和认知的影响

文献信息

中文摘要

引言： 慢性耳鸣是一种常见且致残的疾病，常伴有特定领域的认知困难。异常的神经振荡和跨频率耦合（CFC）紊乱被认为参与其病理生理机制。本研究探讨了根据每位参与者个体α频率（IAF）定制的个体化相位-振幅耦合经颅交流电刺激（tACS）是否与耳鸣症状、认知和神经生理指标的变化相关。
方法： 在这项前瞻性单臂干预研究中，纳入了25名慢性耳鸣（>6个月）成人，其中21人完成了方案。参与者接受五次个体化基于IAF的相位-振幅耦合tACS，电流2 mA，每次20分钟。耳鸣结局包括耳鸣残疾量表（THI）以及响度（VAS-L）和烦恼度（VAS-A）的视觉模拟量表评分。认知表现采用蒙特利尔认知评估、连线测验A和B、数字广度测验顺背和倒背（DST-F/B）以及符号数字模态测验（SDMT）进行评估。在10名参与者的无伪迹亚组中进行了基于脑电图的频谱和CFC分析。
结果： THI评分在干预过程中显著下降，而VAS-L和VAS-A在组水平上未显示显著变化。认知表现在整体认知、处理速度、执行功能和工作记忆方面均有改善。重复测量分析显示DST-F、DST-B和SDMT存在显著的会话效应。DST-B还显示出显著的刺激前至刺激后总体效应，而DST-F的这一效应为边缘性，SDMT则无此效应；未观察到显著的tACS×会话交互作用。经多重比较校正后，CFC分析显示刺激前至刺激后无显著变化。
结论： 重复的个体化基于IAF的相位-振幅耦合tACS与耳鸣相关功能影响减轻以及若干认知指标的改善相关，而主观响度和烦恼度在组水平上未显著变化。未检测到稳健的组水平CFC变化。鉴于单臂设计和缺乏假刺激对照，这些发现是初步的，不能确立治疗特异性或因果效应。需要更大规模的随机假刺激对照研究来确定疗效并阐明潜在的神经生理机制。

英文摘要

INTRODUCTION: Chronic tinnitus is a prevalent and disabling condition that is frequently accompanied by domain-specific cognitive difficulties. Abnormal neural oscillations and disrupted cross-frequency coupling (CFC) have been implicated in its pathophysiology. This study investigated whether individualized phase-amplitude-coupled transcranial alternating current stimulation (tACS), tailored to each participant's individual alpha frequency (IAF), was associated with changes in tinnitus symptoms, cognition, and neurophysiological measures.
METHODS: In this prospective single-arm interventional study, 25 adults with chronic tinnitus (>6 months) were enrolled, and 21 completed the protocol. Participants received five sessions of individualized IAF-based phase-amplitude-coupled tACS at 2 mA for 20 min per session. Tinnitus outcomes included the Tinnitus Handicap Inventory (THI) and visual analog scale ratings of loudness (VAS-L) and annoyance (VAS-A). Cognitive performance was assessed using the Montreal Cognitive Assessment, Trail Making Tests A and B, Digit Span Tests forward and backward (DST-F/B), and Symbol Digit Modalities Test (SDMT). Electroencephalography-based spectral and CFC analyses were conducted in an artifact-free subgroup of 10 participants.
RESULTS: THI scores decreased significantly over the course of the intervention, whereas VAS-L and VAS-A showed no significant group-level changes. Cognitive performance improved across global cognition, processing speed, executive function, and working memory. Repeated-measures analyses demonstrated significant session effects for DST-F, DST-B, and SDMT. DST-B also showed a significant overall pre- to post-stimulation effect, whereas this effect was marginal for DST-F and absent for SDMT; no significant tACS × session interactions were observed. CFC analyses showed no significant pre- to post-stimulation changes after correction for multiple comparisons.
CONCLUSION: Repeated individualized IAF-based phase-amplitude-coupled tACS was associated with reduced tinnitus-related functional impact and improvements in several cognitive measures, whereas subjective loudness and annoyance did not change significantly at the group level. No robust group-level CFC changes were detected. Given the single-arm design and absence of sham control, these findings are preliminary and do not establish treatment-specific or causal effects. Larger randomized sham-controlled studies are needed to determine efficacy and clarify underlying neurophysiological mechanisms.