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目的:观察低频重复经颅磁刺激(rTMS)对帕金森病(PD)患者大脑皮质兴奋性的影响,并从电生理角度进一步探索PD的发病机制。方法:用1HzrTMS技术治疗3 0例PD患者共10d ,另选择15例PD患者为假刺激组,15名健康者为对照组。采用静息态阈值(RT)、中枢传导时间(CMCT)、中枢静息期(CSP)和运动诱发电位(MEP)的波幅作为评定大脑皮质兴奋性的指标。结果:①PD患者的RT、CMCT和CSP较正常对照组明显降低或缩短,而MEP波幅无变化。治疗组治疗后RT增加,CMCT和CSP延长接近正常,与对照组比已无显著差别,但假刺激组没有变化。②以强直症状为主和以震颤症状为主的PD患者其RT、CMCT、CSP和MEP波幅无明显差别。③将PD患者按UPDRS评分的不同分为轻、中、重3种,分别就RT、CMCT、CSP和MEP波幅进行比较,其差别无显著性差异。结论:PD患者大脑皮质兴奋性升高,低频rTMS可部分抑制这种改变,但TMS对评定早期PD患者大脑皮质兴奋性尚不敏感。
Objective: To observe the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) on the excitability of cerebral cortex in patients with Parkinson’s disease (PD) and further explore the pathogenesis of PD from electrophysiological point of view. Methods: Thirty patients with PD were treated with 1 Hz rTMS for 10 days. Fifteen patients with PD were selected as sham stimulation group and 15 healthy controls as control group. The amplitude of resting state threshold (RT), central conduction time (CMCT), central resting period (CSP), and motor evoked potential (MEP) were used as indicators for assessing the excitability of the cerebral cortex. Results: ①The RT, CMCT and CSP of patients with PD were significantly lower or shorter than those of the normal control group, while the changes of MEP amplitude did not change. Treatment group after treatment increased RT, CMCT and CSP extension close to normal, compared with the control group no significant difference, but there was no change in the sham stimulation group. ② There was no significant difference in the amplitude of RT, CMCT, CSP and MEP between patients with predominant symptoms of tonic symptoms and those with tremor symptoms. ③ According to UPDRS score, PD patients were divided into three groups: light, medium and heavy, respectively. There was no significant difference in the amplitudes of RT, CMCT, CSP and MEP. CONCLUSIONS: The excitability of cerebral cortex is increased in PD patients. Low-frequency rTMS partially inhibits this change. However, TMS is not sensitive to evaluate the excitability of cerebral cortex in early-stage PD patients.