重复经颅磁刺激对帕金森病非运动症状康复疗效的研究  

Rehabilitating the non-motor symptoms of Parkinson＇s disease using repetitive transcranial magnetic stimula- tion

作　　者：苏敏[1] 韩立影[1] 刘传道[1] 昝云强[1] 杨卫新[1] 

机构地区：[1]苏州大学附属第一医院康复医学科,苏州215006

出　　处：《中华物理医学与康复杂志》2012年第12期911-915,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的探讨重复经颅磁刺激（rTMS）对帕金森病（PD）患者非运动症状的康复疗效。方法选取PD患者55例，按随机数字表法分为治疗组和假刺激组，治疗组29例，假刺激组26例。治疗组患者给予频率为0．5Hz的经颅磁刺激治疗，假刺激组患者以同样方式置于经颅磁刺激仪器下，但仪器无能量输出。分别于治疗前、治疗后和治疗后1个月采用30项非运动症状筛查问卷（NMSQuest）、汉密尔顿抑郁量表（HAMD）、帕金森病睡眠量表（PDSS）、简易精神状态量表（MMSE）及帕金森病自主神经症状量表（SCOPA-AUT）对患者的非运动症状发生率、抑郁状况、睡眠状况、认知功能及自主神经功能障碍程度进行评定。结果与治疗前相比，治疗组治疗后NMSQuest评分显著下降（P〈0．05），治疗后1个月，治疗组非运动症状改善效果与治疗前相比并不显著（P〉0．05），但假刺激组治疗后及治疗后1个月NMSQuest评分逐渐增高（P〈0．05），2组比较，治疗组疗效明显优于假刺激组（P〈0．05）；治疗组治疗后及治疗后1个月的HAMD评分较治疗前均降低（P〈0．05），假刺激组治疗后及治疗后1个月的HAMD评分逐渐增高（P〈0．05），治疗后及治疗后1个月治疗组患者抑郁改善程度均优于假刺激组（P〈0．05）；治疗组治疗后睡眠障碍明显缓解（P〈0．05），治疗后1个月，治疗组睡眠障碍改善效果与治疗前相比并不显著（P〉0．05），而假刺激组PDSS评分逐渐降低，虽然患者的睡眠障碍未明显加重（P〉0．05），但2组同时间点比较，治疗组睡眠障碍改善效果均优于假刺激组（P〈0．05）；治疗组治疗后认知功能水平提高（P〈0．05），但治疗后1个月时认知功能改善效果减退（P〉0．05），而假刺激组MMSE量表得分逐渐下降（P〉0．05），治疗组与假刺激组相比，组问差异有统计学意义（P〈0．05）；治�Objective To research the clinical rehabilitative effect of repeated transcranial magnetic stimu- lation （rTMS） for the non-motor symptoms of Parkinson＇s disease. Methods Fifty-five PD patients were randomly divided into an rTMS treatment group （ n = 29 ） and a sham stimulation group （ n = 26 ）. The treatment group received a course of 0.5 Hz rTMS treatment, while the sham stimulation group had the same treatment but with no energy out- put. Both groups were evaluated using a non-motor symptoms questionnaire （NMSQuest） , the Hamilton depression scale （HAMD） , the Pediatric Daytime Sleepiness Scale （PDSS） , the mini-mental state examination （MMSE） and the scale for outcomes in PD for autonomic symptoms （SCOPA-AUT） before treatment, immediately after, and a month after treatment. Results Compared with before treatment, the average NMSQuest score of the treatment group declined significantly, though 1 month after treatment the improvement was no longer significant. After treat- ment and 1 month later the average NMSQuest score of the sham stimulation group increased gradually. The effect in the treatment group was therefore significantly better than in the sham stimulation group. After treatment and 1 month later the average HAMD score of the treatment group was significantly lower than before treatment while the average HAMD score of the sham stimulation group had increased gradually. The improvement in depression in the treatment group was therefore significantly better than in the sham stimulation group. After treatment, sleep disorders in the treatment group had been significantly alleviated, but one month later the improvement was no longer significant com- pared with before treatment. PDSS scores in the sham stimulation group declined gradually, but the improvement in sleep disorders among the treatment group was significantly better than among the sham stimulation group. Cognition improved significantly among the treatment group right after treatment, but 1 month later it had

关 键 词：经颅磁刺激 帕金森病 非运动症状 康复疗效 

分 类 号：R742.5[医药卫生—神经病学与精神病学]