低频重复经颅磁刺激治疗视觉空间忽略的临床研究

目的：采用低频重复经颅磁刺激（rTMS）对视觉空间忽略的患者进行治疗,通过行为学方法观察其治疗前后忽略的变化并探讨其脑机制。方法：14例脑血管意外后伴视觉空间忽略两周后无自然恢复的患者,分为治疗组和对照组各7例,治疗组采用rTMS进行治疗,刺激强度为运动阈值的90%,频率0.5Hz,刺激位点位于患者健侧大脑的顶叶后部（EEG10-20标准的P3点）。每次治疗15min,每天2次,连续治疗2周。并连续观察治疗两周后忽略的变化情况。结果：经过rTMS对左侧大脑的顶叶后部进行连续刺激两周后,患者的忽略明显改善。其中线段划消及直线二等分测试均表现为治疗前后有明显的差异。结论：使用rTMS后,患者的视觉空间忽略明显改善。经颅磁刺激治疗作为一种无创性的治疗方法,对视觉空间忽略有效。本结果支持注意网络的半球竞争理论。

Effects of low frequency repetitive transcranial magnetic stimulation on patients with visual spatial neglect

Objective: To investigate the effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on patients with visual spatial neglect and to explore the potential mechanisms of the visual spatial neglect. Method: Fourteen patients with visual spatial neglect whose symptoms were not eliminated naturally had been involved in this study. They were divided into two groups as control group and treatment group. The treatment group was treated with low frequency repetitive rTMS for 2 weeks, two times a day and 15 minutes each, the frequency of the stimulation is 0.5Hz. The stimulant position is the left posterior parietal cortex (ie. the position P3 according to 10-20 EEG coordinate system). All the patients performed a battery of task including line bisection, line cancellation 2 weeks before,at the beginning, the end and 2 weeks after the treatment. Result: By using the low frequency rTMS, we found the treatment group patients, performance improved significantly. Conclusion: There is a significant improvement in visual spatial performance by using low frequency rTMS. The outcome suggested that using low frequency rTMS, as a non-invasive method, might be an effective rehabilitative treatment for patients with visual spatial neglect. The results of our studies support a theory of inter-hemispheric competition in the attentional network.