低频与Theta节律重复经颅磁刺激对帕金森病运动症状改善的临床研究

发布时间：2018-08-22 16:46

【摘要】：背景:帕金森病(Parkinson’s disease,PD)是一种以运动障碍为主要表现的疾病,运动症状来源于黑质向纹状体输送多巴胺(Dopamine,DA)神经元变性缺失。帕金森病的主要运动症状有静止性震颤、肌强直、运动迟缓和姿势步态异常。面对帕金森病这一神经退行性疾病,目前治疗手段主要是药物和手术外科治疗,而采用重复经颅磁刺激(r TMS)这种无创性辅助治疗是另一个选择。国际指南中认为双侧初级运动区(M1区)高频刺激对帕金森病患者改善运动症状有效(C级证据),短期和长期疗效均高于假刺激对照组。目的:使用统一帕金森病评定量表(UPDRS)第三部分评分进行评估和观察r TMS对帕金森病患者运动症状的改善和治疗作用。并通过分析国内外的最新研究成果来对r TMS的作用机制和未来发展和改进方向进行探讨。方法:将24例患者随机分入治疗组A或治疗组B。给予治疗组A低频1Hz1 1 0%A M T r T M S刺激辅助运动区(S M A区),给予治疗组B t h e t a节律高频80%AMT r TMS刺激初级运动区(M1区),两组的刺激治疗时间均为每天1次,一周5次,连续2周,合共10次刺激治疗。疗程前后进行量表评分。结果:1、治疗组A在治疗前后U P D R S第三部分评分总分值、强直部分分值、中轴症状部分分值差异有统计学意义,震颤和运动迟缓部分分值没有统计学差异;治疗组B在治疗前后UPDRS第三部分评分总分值、运动迟缓部分分值差异有统计学意义,中轴症状部分分值、震颤和强直部分分值没有统计学差异。2、A、B两个治疗组间在治疗后的强直部分分值上有明显差异,P=0.0 0 8,组间其余项目比较无明显差异,P0.0 5。结论:1、低频与T h e t a节律重复经颅磁刺激对帕金森病患者的运动症状有改善效果,但效果有限,未能达到明显的临床疗效。2、低频S M A区的重复经颅磁刺激对患者的中轴症状、肌强直改善效果相对明显,未能帮助改善患者的静止性震颤和运动迟缓。而Theta节律M1区重复经颅磁刺激对患者的运动迟缓有部分改善,未能帮助改善患者的中轴症状、静止性震颤和强直症状。
[Abstract]:Background: Parkinson's disease (PD) is a disease characterized by motor dysfunction. Motor symptoms are caused by the loss of dopamine (DA) neurons in the substantia nigra (substantia nigra) to the striatum. The main motor symptoms of Parkinson's disease are quiescent tremor, myotonia, motor retardation, and gait abnormalities. In the face of the neurodegenerative disease of Parkinson's disease, drug and surgical treatment are the main treatment methods at present, and non-invasive adjuvant therapy such as repetitive transcranial magnetic stimulation (r TMS) is another option. International guidelines suggest that high frequency stimulation in bilateral primary motor area (M1) is effective in improving motor symptoms in patients with Parkinson's disease (grade C evidence), and the short-term and long-term effects are higher than those in the sham stimulation control group. Objective: to evaluate and observe the effect of r TMS on the improvement and treatment of motor symptoms in patients with Parkinson's disease (PD) by using the United Parkinson disease rating scale (UPDRS). The mechanism, future development and improvement of r TMS are discussed by analyzing the latest research results at home and abroad. Methods: 24 patients were randomly divided into treatment group A or treatment group B. The treatment group was given A low frequency 1Hz1 10 0 and A M T r T M S stimulation to assist motor area (S M A), and the treatment group was given B t h e t a rhythm high frequency 80%AMT r TMS to stimulate primary motor area (M1 area). The stimulation time of both groups was 1 time per day. Five times a week for 2 weeks, a total of 10 stimuli. The scales were scored before and after the treatment. Results in the treatment group A, there were significant differences in the total score of the third part of U P D R S, the score of the ankylosis part and the score of the central axis symptom before and after treatment, but there was no significant difference between the two groups in the score of tremor and motor retardation. Before and after treatment, the total score of the third part of UPDRS and the score of the part of motor retardation in group B were significantly different. There was no significant difference in the scores of tremor and ankylosis between the two groups. There was a significant difference in the scores of the tetanic parts between the two groups after treatment (P < 0.05), but there was no significant difference in the other items between the two groups (P 0.05). Conclusion low frequency and T h e t a rhythm repetitive transcranial magnetic stimulation can improve motor symptoms of Parkinson's disease, but the effect is limited. No obvious clinical effect was achieved. Repetitive transcranial magnetic stimulation in low frequency S M A region could not improve the symptoms of central axis and muscle myotonia, but could not help to improve the static tremor and motor retardation of the patients. But repeated transcranial magnetic stimulation (TMS) in the M1 region of Theta rhythm can partly improve the motor retardation in patients, but it does not help to improve the symptoms of central axis, static tremor and ankylosis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.5

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