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低频重复经颅磁刺激在帕金森病中的康复治疗作用
引用本文:高峻岭,梅元武,张振建,俞善纯,包敏.低频重复经颅磁刺激在帕金森病中的康复治疗作用[J].中华物理医学杂志,2003,25(11):672-674.
作者姓名:高峻岭  梅元武  张振建  俞善纯  包敏
作者单位:华中科技大学同济医学院附属协和医院神经内科 430022武汉(高峻岭,梅元武,张振建,俞善纯),华中科技大学同济医学院附属协和医院神经内科 430022武汉(包敏)
摘    要:目的 探讨低频重复经颅磁刺激 (rTMS)对帕金森患者的治疗效果。方法 对 3 5例帕金森病 (PD)患者予以低频rTMS治疗 ,以 60 %最大刺激强度刺激双侧额叶 ,每侧刺激 3 0次 ,频率 0 .5Hz,每日 1序列 ,连续治疗共 7次为 1个疗程。于治疗前、后观察WPDEF评分、汉密尔顿抑郁分级量表 (HAMD)及中枢静止期 (CSP)等指标变化 ,评估rTMS在PD康复及治疗中的作用。结果 低频rTMS治疗后WPDEF评分减少 (P <0 .0 1)。TMS CSP延长 ,HAMD降低 (P <0 .0 5) ,其差异具有显著性。治疗的近期总有效率为 86% ,远期效果有待进一步观察。结论 低频rTMS治疗在减轻PD主要临床症状的同时也能改善其伴随的抑郁状态 ,适用于PD的康复辅助治疗 ;其作用机理为低频rTMS可能增强皮质内抑制而延长CSP ,促进多巴胺的释放 ,以及改善PD伴随的抑郁心境

关 键 词:低频重复经颅磁刺激  帕金森病  康复治疗  汉密尔顿抑郁分级量表  WPDEF评分
修稿时间:2003年6月17日

Low-frequency repetitive transcranial magnetic stimulation as rehabilitative treatment in Parkinson's disease
GAO Jun-ling,M EI Yua n-wu,ZHANG Zhen-jian,YU Shan-chun,BAO min.Low-frequency repetitive transcranial magnetic stimulation as rehabilitative treatment in Parkinson''s disease[J].Chinese Journal of Physical Medicine and Rehabilitation,2003,25(11):672-674.
Authors:GAO Jun-ling  M EI Yua n-wu  ZHANG Zhen-jian  YU Shan-chun  BAO min
Institution:GAO Jun-ling,M EI Yua n-wu,ZHANG Zhen-jian,YU Shan-chun,BAO min. Department of Neurology,Xiehe Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430011,China
Abstract:Objective To study the therapeutic effec ts of low-frequency repetitive transcranial magnetic stimulation (rTMS) on patien ts with Parkinson's Disease (PD). MethodsThirty-fi ve PD patients were treated with low frequency rTMS, each side of the prefrontal lobe was applied with 30 stimulations each day. The intensity is 60% of the max imum intensity, and frequency 0.5Hz. The low frequency rTMS treatment lasted fo r 7 consecutive days. Before and after the rTMS treatment, we evaluated the pati ents by use of the Webster Parkinson's Disease Evaluation Form (WPDEF), Hamilton Depression Scale (HAMD), and recorded the variables of TMS-induced motor evok ed potential(MEP), which was recordedfrom the Abductor Pollicis brevis muscle. O ne of the variables the central silent period (CSP)is chosen to measure the change after low-frenquency rTMS since it is significantly shortened in those P D patient without any kind of therapy including those of L-Dopa. ResultsAfter the treatment of low-frequency rTMS, the patients s cored significantly lower on WPDEF( P <0.05) and HAMD( P <0.05). There was a very significant prolongation of TMS-CSP( P <0.01). The total short-term ef ficient rate of low-frequency rTMS was 86%, yet the long-term effect of rTMS is still to be studied. ConclusionLow frequency rTM S is efficient to relieve the clinical symptoms of PD, at the same time the conc omitant symptoms such as neurosis and depression also alleviated. Low-frequency rTMS may enhance the intracortical inhibition (ICI), prolong the Central Silent Period (CSP). rTMS of the prefrontal cortex may induce the release of endogenou s dopamine. This experiment has implications for the therapeutic and research us e of rTMS in neurological and psychiatric disorders such as PD and depression in the rehabilitative treatment.
Keywords:Parkinson's disease  Repetitive TMS  Re habilitative treatment
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