M1区联合背外侧前额叶高频重复经颅磁刺激对脊髓损伤后神经病理性疼痛患者脑电图θ振幅的效果  

Effect of high-frequency repetitive transcranial magnetic stimulation in M1 region combined with dorsolateral prefrontal cortex on electroencephalogramθfrequency band amplitude of patients with neuropathic pain after spinal cord injury

作　　者：刘冬 徐子涵 李江[1] 鞠萍 LIU Dong;XU Zihan;LI Jiang;JU Ping(Qingdao University Affiliated Hospital,Qingdao,Shandong 266000,China;Chinese People's Liberation Army Navy Qingdao Special Service Rehabilitation Center,Qingdao,Shandong 266000,China;The Second People's Hospital of Shandong Province,Ji'nan,Shandong 250023,China)

机构地区：[1]青岛大学附属医院,山东青岛市266000 [2]中国人民解放军海军青岛特勤疗养中心,山东青岛市266000 [3]山东省第二人民医院,山东济南市250023

出　　处：《中国康复理论与实践》2024年第1期87-94,共8页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的探索左侧M1区联合背外侧前额叶(DLPFC)高频重复经颅磁刺激(rTMS)对脊髓损伤后神经病理性疼痛(NP)的效果及脑电图θ频段振幅的变化。方法2022年6月至2023年6月,青岛大学附属医院脊髓损伤后NP患者50例,随机分为M1区刺激组(n=25)和M1区DLPFC联合刺激组(联合刺激组,n=25)。M1区刺激组接受左侧M1区10 Hz rTMS,联合刺激组接受左侧M1区DLPFC联合rTMS,共3周。干预前后,采用简化McGill疼痛问卷(SF-MPQ)、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)进行评估,脑电图θ频段振幅评估大脑电生理活动变化。结果M1区刺激组脱落4例,联合刺激组脱落2例。干预后,两组SF-MPQ总分及各子量表评分,HAMD评分和HAMA评分均降低(|t|>2.523,P<0.05),M1区刺激组前额区和额区θ频段平均振幅显著下降(|t|>5.243,P<0.001),联合刺激组前额区、额区、中央区和顶区θ频段平均振幅显著下降(|t|>4.630,P<0.001);联合刺激组SF-MPQ总分及各子量表评分,HAMD评分和HAMA评分均低于M1刺激组(|t|>2.270,Z=-1.973,P<0.05),联合刺激组前额区、额区、中央区、顶区θ频段平均振幅均低于M1区刺激组(P<0.05)。结论高频rTMS是脊髓损伤后NP患者的有效镇痛手段,可以改善患者的抑郁、焦虑症状,降低θ频段振幅。与M1区rTMS刺激相比,M1区DLPFC联合rTMS疗效更显著。Objective To explore the efficacy of high-frequency repetitive transcranial magnetic stimulation(rTMS)in M1 region combined with dorsolateral prefrontal cortex(DLPFC)on electroencephalogram(EEG)θfrequency band amplitude of patients with neuropathic pain(NP)after spinal cord injury.Methods From June,2022 to June,2023,50 NP patients after SCI in Qingdao University Affiliated Hospital were included and divided into M1 region stimulation group(n=25)and M1 region combined with DLPFC stimulation group(the combined stimulation group,n=25).M1 region stimulation group received 10 Hz rTMS in the left M1 region,while the combined stimulation group received same stimulation in left M1 region combined with DLPFC,for three weeks.Before and after intervention,the pain was assessed with Short Form of McGill Pain Questionnaire(SF-MPQ),the depression and anxiety status were evaluated using Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA),and the EEGθfrequency band amplitude was recorded to detect the changes of brain electrophysiological activity.Results Four cases in M1 region stimulation group,and two cases in the combined stimulation group were dropped.After intervention,the total score of SF-MPQ and the scores of the subscales,the scores of HMMD and HAMA decreased in both groups(|t|>2.523,P<0.05).The EEGθfrequency band amplitude significantly reduced in the prefrontal and frontal regions in M1 region stimulation group(|t|>5.243,P<0.001),and it also significantly reduced in the prefrontal,frontal regions,central and parietal regions in the combined stimulation group(|t|>4.630,P<0.001).All the scores were lower(|t|>2.270,Z=-1.973,P<0.05),and the EEGθfrequency band amplitude in the prefrontal,frontal regions,central and parietal regions were lower(P<0.05)in the combined stimulation group than in M1 region stimulation group.Conclusion High frequency rTMS is an effective analgesic method on NP after SCI,which can improve their depression and anxiety symptoms and reduce the EEGθfrequency band amplitude.Compared w

关 键 词：脊髓损伤 神经病理性疼痛 重复经颅磁刺激 脑电图 θ频段振幅 

分 类 号：R651.2[医药卫生—外科学]