重复经颅磁刺激及VR体感游戏在儿童注意缺陷多动障碍中的应用效果研究

Study on the application effects of repetitive transcranial magnetic stimulation and VR somatosensory games in children with attention deficit hyperactivity disorder

摘要

目的 探讨重复经颅磁刺激(rTMS)联合虚拟现实(VR)体感游戏在注意缺陷多动障碍(ADHD)患儿中的应用效果。方法 选取2020年8月至2023年12月于西安交通大学第一附属医院就诊的129例ADHD患儿为研究对象,按照随机数字表法分为rTMS组、VR组、联合组.rTMS组给予rTMS,VR组给予VR体感游戏,联合组给予rTMS联合VR体感游戏,比较3组疗效、核心症状[中文版注意缺陷多动障碍斯诺佩评估量表Ⅳ(SNAP-Ⅳ)父母版]、注意力[数字划消测验(NCT)]、行为问题[Conners父母评价量表(PSQ)]、神经系统相关因子[血清脑源性神经生长因子(BDNF)、胶质源性神经生长因子(GDNF)、神经元特异性烯醇化酶(NSE)]、安全性。结果 联合组总有效率(95.35%),高于VR组(76.74%)和rTMS组(79.07%)(χ²=6.484,P<0.05),治疗后联合组SNAP-Ⅳ父母版的多动/冲动、对立违抗、注意缺陷评分及总分低于rTMS组、VR组(F=23.564、28.382、14.565、60.998,P<0.05),治疗后联合组划对数、净分高于rTMS组、VR组,划错数、划漏数低于rTMS组、VR组(F=75.972、125.532、91.332、21.101,P<0.05),治疗后联合组学习问题、心身障碍、冲动-多动、焦虑、多动指数评分低于rTMS组、VR组(F=66.656、94.269、65.547、92.886、30.262,P<0.05),治疗后联合组BDNF、GDNF高于rTMS组、VR组,NSE低于rTMS组、VR组(F=34.623、61.129、42.200,P<0.05),3组均未发生不良反应。结论 rTMS联合VR体感游戏治疗ADHD效果显著,可改善患儿临床症状、注意力缺陷及行为问题,促进患儿认知神经功能恢复,且安全性高.

Abstract

Objective To explore the application effect of repetitive transcranial magnetic stimulation (rTMS) combined with virtual reality (VR) somatosensory games in children with attention deficit hyperactivity disorder (ADHD). Methods A total of 129 children with ADHD who visited the First Affiliated Hospital of Xi′an Jiaotong University from August 2020 to December 2023 were selected as study subjects. Using a random number table method, they were divided into three groups: the rTMS group, the VR group, and the combined group. The rTMS group received rTMS treatment, the VR group received VR somatosensory game therapy, and the combined group received rTMS combined with VR somatosensory games. The study compared the three groups regarding efficacy, core symptoms [Chinese version of the Swanson, Nolan, and Pelham Rating Scale Ⅳ (SNAP-Ⅳ) Parent Version], attention [Number Cancellation Test (NCT)], behavioral problems [Conners′ Parent Rating Scale (PSQ)], neurological-related factors [serum brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), and neuron-specific enolase (NSE)], and safety. Results The total effective rate in the combined group (95.35%) was significantly higher than that in the VR group (76.74%) and the rTMS group (79.07%) (χ²=6.484, P<0.05). After treatment, the combined group showed lower SNAP-Ⅳ Parent Version scores for hyperactivity/impulsivity, oppositional defiance, inattention, and total score compared to the rTMS and VR groups (F=23.564, 28.382, 14.565 and 60.998, respectively, P<0.05). Post-treatment, the combined group had higher correct number and net score in the NCT, and fewer errors and omissions compared to the rTMS and VR groups (F=75.972, 125.532, 91.332 and 21.101, respectively, P<0.05). Additionally, the combined group had lower scores for learning problems, psychosomatic disorders, impulsivity-hyperactivity, anxiety, and hyperactivity index than the rTMS and VR groups (F=66.656, 94.269, 65.547, 92.886 and 30.262, respectively, P<0.05). After treatment, BDNF and GDNF levels were higher in the combined group than in the rTMS and VR groups, while NSE levels were lower (F=34.623, 61.129 and 42.200, respectively, P<0.05). No adverse reactions were observed in any group. Conclusion rTMS combined with VR somatosensory games demonstrates significant therapeutic effects in children with ADHD. This combined therapy improves clinical symptoms, attention deficits, and behavioral problems, promotes cognitive and neurological recovery, and has a high safety profile.

关键词

儿童 / 注意缺陷多动障碍 / 重复经颅磁刺激 / VR体感游戏 / 认知神经功能 / 神经营养因子

Key words

child / attention deficit hyperactivity disorder / repetitive transcranial magnetic stimulation / VR somatosensory game / cognitive neurological function / neurotrophic factor

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基金资助

陕西省重点研发计划项目(2020SFG741)