| Objective: The clinical efficacy of TMS in the treatment of nonorganic insomnia has been shown in numerous studies,and most previous studies have only demonstrated the effectiveness of rTMS interventions for nonorganic insomnia,but less research has been conducted on the internal mechanisms of the brain.The aim of this study was to recognize the brain intervention brain by non-invasive means,to explore the characteristics of alterations in working memory and brain networks in subjects,and to evaluate its feasibility and explore the internal mechanisms.Methods: From October 2021 to June 2022,40 subjects who met the inclusion criteria were screened at Bengbu Medical College,including 20 nonorganic insomniacs and 20 healthy controls.All subjects in both groups were first given a neuropsychological assessment(including PSQI,HAMA,HAMD,etc.),resting-state EEG and task-state EEG(task-state EEG selected as a digital N-back task with a difficulty load of N=2),and only the nonorganic insomnia group was treated with the1 Hz rTMS intervention,and the aforementioned assessment items were performed again after completing all interventions as required.Neuropsychological assessments were processed by score in SPSS 25.0 software;resting-state EEG was pre-processed in Mat Lab software,then resting-state brain network connectivity analysis was performed by HERMES and NBS plug-ins,and study was created for resting-state frequency domain analysis;ERP was analyzed and processed by Net Station software to extract Fz,Cz,Pz The latency,wave amplitude and behavioural data of P300 and N2 at the electrode points were extracted,and the P300 traceability of the task state was localised in the Geo Source toolbar,and the traceability attributes of the two groups of subjects were analysed and compared.Results:(1)Neuropsychological: Before the intervention,the non-organic insomnia group had significantly higher PSQI and HAMA(P< 0.05),and after the intervention,sleep quality,efficiency,daytime dysfunction and HAMA in PSQI had significant improvement.(2)Resting-state EEG: the functional connectivity strength of brain networks in the nonorganic insomnia group was higher than that of the control group in the Theta,Beta and Gamma bands,while it was lower than that of the control group in the Delta and Alpha bands,but there was no statistically significant difference;in the power spectrum of resting-state frequency domain analysis,the significant difference was mainly concentrated in the parieto-occipital part of the Gamma band;and after the intervention,the Gamma band improved significantly with statistical significance after the intervention(P < 0.05).(3)Task state EEG: compared to healthy controls,the nonorganic insomnia group had significantly lower Fz and Cz point P300 wave amplitude in 0-back,Fz point P300 wave amplitude in 1-back and Fz point P300 wave amplitude and latency in 2-back.rTMS intervention after one session,Fz and Cz in 0-back and Fz point wave amplitude and latency in 2-back.The wave amplitude and latency of Fz and Cz in0-back and Fz in 2-back were significantly improved after one session of rTMS intervention(P < 0.05).The N2 component was statistically significant in the wave amplitude of Fz and Cz electrode points in the 0-back and 2-back in the non-organic insomnia group compared to healthy controls,and was significantly lower in the nonorganic insomnia group at both electrode points(P < 0.05);whereas the N2 wave amplitude at Cz electrode points in the 2-back task showed significantly higher after the rTMS intervention in the comparison between groups(P < 0.05)No significant change in latency was observed.The current intensity of the activation areas in the nonorganic insomnia group was significantly lower in the 0-back and 2-back,and improved significantly in the 2-back after the rTMS intervention.In the healthy group,the activation areas during the working memory task were mainly concentrated in the frontal part(Brodamnn subdivision 11),while in the nonorganic insomnia group the activation areas were more dispersed and improved after the intervention.Conclusion: 1.Task state EEG(P300 component,P300 retrospective analysis,N2component)and resting state(functional brain network connectivity strength,power spectrum)are feasible for the objective clinical assessment of nonorganic insomnia.2.rTMS intervention is effective in improving the subjective symptoms of nonorganic insomnia and can improve subjects’ working memory,executive control and brain function network disorders by modulating brain function.It provides a theoretical basis for future precise assessment and targeted interventions. |
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