应用低频重复经颅磁刺激治疗头颈部肌张力障碍  

Low frequency repetitive transcraniai magnetic stimulation in the diagnosis and treatment of cranial dystonia

作　　者：刘宁疆[1] 张本恕[2] 谢炳约[2] 陶华英[2] 崔林阳[2] 

机构地区：[1]天津医科大学总医院急诊科,300052 [2]天津医科大学总医院神经内科,300052

出　　处：《中华神经科杂志》2008年第6期389-392,共4页Chinese Journal of Neurology

摘　　要：目的观察低频重复经颅磁刺激（rTMS）对头颈部肌张力障碍患者的治疗效果。方法采用低频rTMS治疗20例头颈部肌张力障碍患者，分别于治疗前、治疗后1d以及治疗后1、2、6个月观察其临床疗效评分[西多伦多痉挛性斜颈（TWSTRS）评分]，同时记录治疗前后的运动诱发电位。结果20例患者经rTMS治疗后1、2个月的TWSTRS评分[（17．6±14．3）、（18．5±14．2）分]与治疗前[（23．5±14．0）分]相比明显下降（t=2．632、2．149，均P〈0．05），但治疗后2个月时的评分较治疗后1个月有所回升。2个月内总有效率为60％（12／20），远期疗效有待进一步观察。与治疗前（46．5％±7．3％．40．2％±5．9％）相比，患者治疗后的静息阈值（49．9％±9．2％，t=-3．235，P〈0．05）、易化阈值（43．9％±8．8％，t=-2．339，P〈0．05）升高，皮质静止期显著延长[分别为（96．1±24．5）、（121．6±27．7）ms，t=-7．223，P=0．000]。结论低频rTMS有助于缓解头颈部肌张力障碍患者的症状，短期内临床症状改善明显。Objective To study the therapeutic effects of low frequency repetitive transcranial magnetic stimulation （rTMS） in cranial dystonia. Methods Twenty cranial dystoina patients were treated with low frequency rTMS. Their motor threshold, cortical silent period （CSP） were evaluated before and after the rTMS and after 1, 2, 6 months as well as the spams and Toronto Western Spasmodic Torticollis Rating Scale （TWSTRS） to evaluate the effects of rTMS in the treatment of cranial dystonia. Results The patients scored（23.5 ± 14. 0） significantly lower after 1 and 2 months（ 17.6 ± 14. 3,18. 5 ± 14. 2,t =2. 632, 2. 149,both P 〈 0. 05 ）. But there was an increasing tendency of the score after 2 months. The 2-month efficient rate of low-frequency rTMS was 60% （ 12/20）, yet the long-term effect of rTMS was still to be studied. There was a very significant improvment of relaxed （46. 5% ± 7.3% vs 49. 9% ± 9.2%, t = - 3. 235 ,P 〈0. 05） and active threshold （40. 2% ＋ 5.9% vs 43.9% ± 8. 8%, t = - 2. 339, P 〈 0.05 ）, prolongation of CSP （ （96. 1 ± 24. 5 ） ms vs （ 121.6 ± 27.7 ） ms, t = - 7. 223, P = 0. 000）. Conclusion The low frequency rTMS is efficient to relieve the clinical symptoms of cranial dystonia.

关 键 词：斜颈 磁力学 治疗结果 

分 类 号：R686[医药卫生—骨科学]