低频重复经颅磁刺激对难治性癫发作频率、静息运动阈值、SPECT的影响  

Effects of Low-frequency Repetitive Transcranial Magnetic Stimulation on Seizures,Resting Motor Threshold,and Single Photo Emission Computered Tomography in Patients with Intractable Epilepsy

作　　者：王莉[1] 余巨明[1] 余琴[1] 

机构地区：[1]川北医学院附属医院神经内科,637000

出　　处：《中国临床神经科学》2011年第4期352-356,共5页Chinese Journal of Clinical Neurosciences

基　　金：四川省科技厅重点攻关项目(编号:05SCT022-016)

摘　　要：目的:观察低频重复经颅磁刺激(rTMS)的抗癫疗效及可能机制。方法:对4例难治性癫患者灶所在脑区给予rTMS治疗(0.5 Hz,45%最大输出强度,每天15串、100次/串、串间隔30 s,连续10 d),观察治疗前后各3个月患者的临床发作及1 h时长的脑电图癫波数量,并行单光子发射断层摄影(SPECT)和静息运动阈值检查,以观察感兴趣区(ROI)放射线摄取比值的变化和皮质兴奋性改变。结果:4例患者经rTMS治疗后,3例无发作,1例发作1次。脑电图:1例癫波减少了20%;4例静息运动阈值均增高。SPECT:4例均显示rTMS后ROI值进一步降低。结论:低频rTMS对难治性癫有治疗作用,其抗癫作用可能与减少癫灶局部脑血流灌注和增加静息运动阈值有关。Aim：To investigate the effect of low-frequency repetitive transcranial magnetic stimulation（rTMS） on intractable epilepsy,and explore its underlying mechanisms by using resting motor threshold（RMT） and single photo emission computered tomography（SPECT）,respectively.Methods：4 intractable epileptic patients with well demarcated epileptogenic zones were enrolled.All patients were given 10-day consecutive rTMS treatment（0.5 Hz,45% stimulator maximum output,15 trains/d,100 pulses/train,interval of 30 s）.The frequency of seizures for 3 months,and the number of interictal spikes on 1-h EEG were counted before and after rTMS,respectively.The SPECT and RMT were used to detect the changes of cerebral blood flow and cortical excitability,respectively.Results：Compared with pre-rTMS treatment,3 patients were seizure free and 1 patient only had one seizure in the 3-month follow-up period after rTMS;the number of interictal spikes in one patient decreased by 20%（the other three patients had no spikes on EEGs before and after rTMS）;the RMT was clearly elevated and the SPECT analysis showed the ROI values further decreased in all of the 4 patients.Conclusion：This study suggested that rTMS was effective in the treatment of patients with intractable epilepsy,and this effects might be related to the elevation of RMT and the reduction of the cerebral perfusion in the epileptogenic zones.

关 键 词：经颅磁刺激 难治性癫 脑电图 单光子发射断层摄影 静息运动阈值 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]