重复经颅磁刺激治疗多发性抽动症患儿前瞻性研究

发布时间：2018-09-14 06:48

【摘要】：目的：研究1Hz低频重复经颅磁刺激(repetitive transcranial magneticstimulation，rTMs)作用于辅助运动区（supplemental motor area，SMA）对多发性抽动症(Tourette syndrome，TS)患儿治疗效果，并随访6个月观察。方法： 1.收集25例确诊TS患儿，年龄7.2-15.4岁之间，男22例，女3例，病程1-6.5年。 2. rTMS作用其SMA，频率为1Hz，磁刺激强度为110％静息阈值(resting motor threshold，RMT)，每天1200次脉冲，每周5天，连续4周。 3.于治疗前及治疗2周后、治疗4周后3个时间点分别检测左、右大脑半球RMT；治疗前及治疗2周后、治疗4周后及治疗后3月、治疗后6月5个时间点分别进行耶鲁抽动症整体严重程度量表（Yale Global Tic Severity Scale，YGTSS），临床疗效总评量表（Clinical Global Impression，CGI），SNAP-IV量表（Swanson, Nolan, and Pelham, version IV scale for AHDH，SNAP-IV），Kovacs儿童抑郁量表（Kovacs Children's DepressionInventory，CDI），斯宾塞儿童焦虑量表（Spence Children’sAnxiety Scale，SCAS）及注意力测试（失误率）评估。结果： 1.除1例受试者有一过性轻微嗜睡外，其余24例未发现严重不良反应，耐受性及安全性良好。19例临床症状获得改善，有效率76%。 2.治疗2周后，YGTSS、CGI、CDI评分均值及注意力测试失误率均较治疗前显著下降（P＜0.05），左、右大脑半球RMT较治疗前显著增高（P＜0.05）。 3.治疗4周后，YGTSS、CGI、SNAP-IV、SCAS、CDI评分及注意力测试失误率均较治疗前显著下降（P＜0.05），左、右大脑半球RMT较治疗前显著增高（P＜0.05）。 4.治疗前后左、右大脑半球RMT没有显示出不对称。 5.在治疗后的6个月随访期内，17例受试对象治疗维持有效，有效率68%。 6.随访期内3个月时，YGTSS、CGI、CDI、SCAS评分均值较治疗4周后无显著差异（P＞0.05），SNAP-IV评分均值及注意力测试失误率均较治疗4周后显著下降（P＜0.05）。 7.随访期内6个月时，YGTSS、CGI、CDI评分均值较治疗4周后无显著差异（P＞0.05），，SNAP-IV、SCAS评分均值及注意力测试失误率均较治疗4周后显著下降（P＜0.05）。结论： 1.1Hz、110%RMT低频rTMS作用于药物治疗控制不佳的TS患儿SMA治疗4周，治疗期内能有效改善其抽动症状。 2.采用20天的治疗方案与既往10天方案报道相比，在治疗后期能改善患儿的多动、抑郁及注意力不集中等相关症状。 3.本研究中，68%的患儿疗效能有效维持6个月，有效提高患儿的生活质量，改善患儿家庭关系，是一种有效的、安全的治疗方法。 4. rTMS改善TS患儿症状可能与低频刺激降低大脑皮层兴奋性有关。
[Abstract]:Objective: to study the effect of 1Hz low frequency repetitive transcranial magnetic stimulation (repetitive transcranial magneticstimulation,rTMs) on the treatment of multiple tic syndrome (Tourette syndrome,TS) in children with multiple tic syndrome (Tourette syndrome,TS). Methods: 1. Twenty-five children aged between 7.2-15.4 years old with TS were collected. The course of disease was 1-6.5 years. The SMA, frequency was 1Hz and the magnetic stimulation intensity was 110% resting threshold (resting motor threshold,RMT), 1200 pulses per day, 5 days a week. 4 weeks in a row. 3. Left and right hemisphere RMT; were detected before and 2 weeks after treatment, 4 weeks and 3 months after treatment, respectively. Six months after treatment, five time points were treated with the Yale holistic severity scale (Yale Global Tic Severity Scale,YGTSS), the Clinical efficacy scale (Clinical Global Impression,CGI) and the SNAP-IV scale (Swanson, Nolan, and Pelham, version IV scale for AHDH,SNAP-IV), the Kovacs Children's Depression scale (Kovacs Children's DepressionInventory,CDI), and the Spenser Children's anxiety scale. (Spence Children'sAnxiety Scale,SCAS) and attention test (error rate) were evaluated. Results: 1. Except for one patient with transient mild somnolence, no severe adverse reactions were found in the remaining 24 cases. The clinical symptoms were improved in 19 patients with good tolerance and safety. The effective rate was 76.2%. After 2 weeks of treatment, the mean value of CGI CDI score and the rate of attention failure were significantly decreased (P < 0. 05), and the RMT in left and right hemisphere were significantly higher than that before treatment (P < 0. 05). After 4 weeks of treatment, the CDI score and attention test error rate of SNAP-IVP SCASI were significantly lower than those before treatment (P < 0. 05), and the RMT of left and right cerebral hemispheres were significantly higher than those before treatment (P < 0. 05). Left and right hemisphere RMT showed no asymmetry before and after treatment. During the follow-up period of 6 months after treatment, 17 patients were treated effectively and the effective rate was 68.6%. There was no significant difference (P > 0.05) in the mean value of SCAS score between YGTSS and CGII-CDIN after 4 weeks of treatment (P > 0.05). The mean value of SNAP-IV score and the failure rate of attention test were significantly lower than those after 4 weeks of treatment (P < 0.05). There was no significant difference in the mean value of CGI CDI score between the two groups after 4 weeks of treatment (P > 0.05). The mean score of SNAP-IVI SCAS and the failure rate of attention test were significantly lower than those after 4 weeks of treatment (P < 0.05). Conclusion: 1. 1. Low frequency rTMS of RMT can effectively improve the twitch symptoms of SMA in TS children who are not well controlled by drug therapy for 4 weeks. 2. Compared with the previous 10-day regimen, the 20-day treatment regimen improved hyperactivity, depression and attention-related symptoms in the later stage of treatment. 3. In this study, 68% of the children were effective in maintaining the curative effect for 6 months, effectively improving the quality of life and improving the family relationship of the children. Safe treatment. 4. The improvement of rTMS symptoms in children with TS may be associated with low-frequency stimulation and decreased cortical excitability.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R749.94

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