高频重复经颅磁刺激治疗慢性紧张型头痛的临床观察  

Clinical study of high frequency repetitive transcranial magnetic stimulation in chronic tension-type headache

作　　者：王雷[1] 施雪英[1] 袁良津[1] 陈祚胜[1] Wang Lei;Shi Xueying;Yuan Liangjin;Chen Zuosheng(Department of Neurology,Anqing Hospital,Anhui Medical University,Anqing 246003,China)

机构地区：[1]安徽医科大学附属安庆医院神经内科,安庆246003

出　　处：《中华神经医学杂志》2022年第6期600-605,共6页Chinese Journal of Neuromedicine

摘　　要：目的观察高频重复经颅磁刺激(rTMS)治疗慢性紧张型头痛(CTTH)的有效性和安全性。方法选择安徽医科大学附属安庆医院神经内科自2019年2月至2021年9月收治的38例CTTH患者进入研究并按照随机数字表法分为rTMS组(19例)和对照组(19例)。rTMS组患者使用表面标记法定位右拇短展肌的热点并计算静息态运动阈值(RMT),随后将刺激强度调整为RMT的70%,刺激点位于先前确定的右手拇指热点前5 cm处,即左背外侧前额叶皮质(LDLPFC);刺激频率为每周一、三、五各1次,共持续4周,刺激12轮。对照组不定位热点,不计算RMT,将线圈垂直于LDLPFC放置,使用最小刺激强度,刺激频率同rTMS组。2组患者在rTMS治疗前及治疗4周后通过视觉模拟评分量表(VAS)、头痛影响测试问卷-6(HIT-6)、简易McGill疼痛问卷(MPQ)等量表进行主观疼痛评估,通过伤害性屈曲反射(NFR)和条件性疼痛调节(CPM)试验中相关电生理指标作为疼痛状态的客观评估指标。记录2组患者治疗期间及1个月随访期间的不良反应。结果(1)量表评分:与治疗前比较,rTMS组患者治疗后各量表评分明显下降,差异均有统计学意义(P<0.05)。对照组患者治疗后各量表评分与治疗前比较均无明显变化,差异均无统计学意义(P>0.05)。组间比较方面,与对照组患者比较,rTMS组患者治疗后VAS评分、HIT-6评分、现在疼痛状况(PPI)评分、特质-焦虑量表评分均明显下降,差异均有统计学意义(Z=-4.054,P<0.001;t=-6.083,P<0.001;Z=-4.246,P<0.001;Z=-3.740,P<0.001)。(2)NFR RⅢ参数:与治疗前比较,rTMS组治疗后最低阈值明显上升,差异有统计学意义(P<0.05)。对照组患者治疗后NFR RⅢ参数与治疗前比较差异均无统计学意义(P>0.05)。组间比较方面,与对照组患者比较,rTMS组患者治疗后最低阈值明显上升,差异有统计学意义(P<0.05)。冷压力测试结果显示,与基础NFR RⅢ反射面积比较,2组患者治疗前及治疗后均有Objective To observe the efficacy and safety of high frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of chronic tension-type headache(CTTH)patients.Methods Thirty-eight patients with CTTH,admitted to our hospital from February 2019 to September 2021,were randomly divided into rTMS group and control group(n=19).In the rTMS group,the hot spot of the right abductor pollicis brevis was surface-labeled and the resting movement threshold(RMT)was calculated;the intensity of the stimulus was then adjusted to 70%of RMT,and stimulus was then located at 5 cm in front of the previously identified hot spot of the right thumb,namely the left dorsolateral prefrontal cortex(LDLPFC);the stimulus was delivered once every Monday,Wednesday and Friday,and lasted for 4 weeks with 12 rounds of stimulation.In the control group,the hot spot was not located and RMT was not calculated;the coil was placed perpendicular to LDLPFC;and the stimulation frequency was the same as that in the rTMS group with minimum stimulation intensity.Visual analogue scale(VAS),Headache Impact Test-6(HIT-6),simplified McGill Pain Questionnaire(SF-MPQ)were used to evaluate the subjective pain status.The electrophysiological indices in the nociceptive flexion reflex(NFR)and conditioned pain modulation(CPM)were used to evaluate the objective pain status.Adverse events during treatment and 1-month follow-up were recorded in the two groups.Results(1)Rating scales:scores of all rating scales in the rTMS group after treatment were significantly decreased as compared with those before treatment(P<0.05);however,no significant difference was noted in the control group(P>0.05).After treatment,the scores of VAS,HIT-6,present pain intensity(PPI)scale,and trait anxiety inventory in the rTMS group were significantly decreased as compared with those in the control group(Z=-4.054,P<0.001;t=-6.083,P<0.001;Z=-4.246,P<0.001;Z=-3.740,P<0.001).(2)NFR RIII parameters:as compared with that before treatment,the minimum threshold in rTMS group after treatmen

关 键 词：紧张型头痛 经颅磁刺激 伤害性屈曲反射 条件性疼痛调节 

分 类 号：R741[医药卫生—神经病学与精神病学]