低频重复经颅磁刺激治疗中晚期帕金森病运动功能障碍及对运动皮质兴奋性影响  

Low frequency repeated transcranial magnetic stimulation in the treatment of motor dysfunction in Parkinson’s disease and its effects on motor cortex excitability

作　　者：赵航[1] 葛晗明 张格娟 梁战华[3] ZHAO Hang;GE Hanming;ZHANG Gejuan;LIANG Zhanhua(The First Affiliated Hospital of Xi’an Medical University,Xi’an 710077,China;Xi’an No.3 Hospital,Xi’an 710021,China;The First Affiliated Hospital of Dalian Medical University,Dalian 116044,China)

机构地区：[1]西安医学院第一附属医院,西安710077 [2]西安市第三医院,西安710021 [3]大连医科大学附属第一医院,辽宁大连116044

出　　处：《现代仪器与医疗》2019年第5期16-20,共5页Modern Instruments & Medical Treatment

基　　金：陕西省重点研发项目（No.2015SF-083）;西安市科技计划项目“科技+”行动计划——医学研究项目（201805099YX7SF33(1）

摘　　要：目的:观察连续模式低频重复经颅磁刺激治疗不同类型帕金森的疗效并探讨帕金森病患者运动皮质兴奋性的变化。方法:震颤为主型(tremor-dominant type,TDT),强直与运动迟缓为主型(akinetic-rigid type,ART),混合型(mixed type,MT)帕金森患者各20 例,每一类型患者随机抽取10 例分别进行真刺激和伪刺激治疗。首次连续模式低频重复经颅磁刺激干预前1 天以及末次治疗后30 分钟内,末次治疗2 周后和4 周后分别测定运动诱发电位监测下的静息运动阈值,并应用帕金森病评分量表(Unified Parkinson’s Disease Rating Scale,UPDRS)对患者临床运动功能进行评价。结果:治疗前两组患者的UPDRS 评分差异无统计学意义(P>0.05);末次治疗后30 分钟、末次治疗2 周后以及4 周后,真刺激组UPDRS 评分明显低于同组治疗前(P<0.05),伪刺激组UPDRS评分与同组治疗前比较差异无统计学意义(P>0.05)。真刺激组治疗后3 个时点的UPDRS 评分低于伪刺激组,组间差异有统计学意义(P<0.05)。两组患者治疗前与治疗后30 分钟、治疗2 周后以及4 周后的静息运动阈值差异无统计学意义(P>0.05),两组间同一时点静息运动阈值差异无统计学意义(P>0.05)。结论:重复经颅磁刺激治疗可改善帕金森患者运动症状,但运动诱发电位监测下的静息运动阈值无明显改变。Objective: This study aimed to observe the effect of continuous low-frequency repetitive transcranial magnetic stimulation (TMS) on different types of Parkinson's disease and to explore the changes of motor cortex excitability in patients with Parkinson’s disease. Methods: Tremor-dominant type (TDT), akinetic-rigid type (ART), mixed type (MT) Parkinson’s were 20 cases each group, and 10 patients of each type were selected randomly for true stimulation and false stimulation treatment. One day before the first continuous mode low-frequency repeated transcranial magnetic stimulation intervention and 30 minutes after the last treatment, the resting motion threshold under the monitoring of motor evoked potential was measured at 2 weeks and 4 weeks after the last treatment, respectively, and the clinical motor function of patients was evaluated by applying Unified Parkinson's Disease Rating Scale (UPDRS). Results: Two groups of patients before treatment UPDRS score differences had no statistical significance (P>0.05);30 minutes after the last treatment, the last 2 weeks and 4 weeks after treatment, the UPDRS score really stimulate group was obviously lower group before treatment (P<0.05), the pseudo stimulation group UPDRS score there was no statistically significant difference compared with the same group before treatment (P>0.05). True stimulus set of three points after treatment UPDRS score below pseudo stimulation group, difference between groups was statistically significant (P<0.05). There was no statistically significant difference in resting motion threshold between the two groups before and 30 minutes after treatment, 2 weeks after treatment and 4 weeks after treatment (P>0.05), and no statistically significant difference in resting motion threshold between the two groups at the same time point (P>0.05). Conclusions: Repetitive TMS can improve the motor symptoms of Parkinson’s disease, but the threshold of resting motor movement under the monitoring of motor evoked potential has no significant change.

关 键 词：中晚期帕金森病 低频重复经颅磁刺激 帕金森病评分量表 静息运动阈值 

分 类 号：R741.05[医药卫生—神经病学与精神病学]