重复经颅磁刺激治疗帕金森病效果及脑功能连接的研究

发布时间：2019-02-12 21:40

【摘要】：背景：帕金森病又称原发性震颤麻痹,是多发于中老年群体的一种神经退行性疾病,在60岁以上人群中患病率高达1000/10万,并随年龄增长而增高。在我国,随着老龄化时代的到来,帕金森病患者明显增多。传统的药物治疗不仅给患者带来了很大的副作用,而且药效会逐渐减退甚至不起作用。功能神经外科的手术疗法和深部脑刺激治疗的出现给帕金森病患者带来了一线曙光,但是这些有创的治疗方式以及其昂贵的费用让大多数患者望而却步。自从重复经颅磁刺激问世以来,不断地被用于各种临床疾病的研究与治疗。目前研究表明,重复经颅磁刺激对帕金森病有很好的治疗效果,大部分研究选取运动一区作为治疗位点。目的：观察5Hz重复经颅磁刺激辅助运动区的治疗是否能够改善患者的运动症状,及其对脑功能连接的影响。方法：研究采用了单样本设计。按照诊断标准和测量标准收入帕金森患者9名,用UPDRS量表,MMSE量表和言语流畅性测试来评估患者的基线水平,并且收取其静息态功能核磁共振数据；然后,要求患者服药2小时后开始重复经颅磁刺激治疗,治疗参数为：5Hz/100%RMT/1600脉冲刺激,治疗位点在辅助运动区,共治疗2周,每周5次,共10次；在治疗结束后再次评估和核磁共振扫描。其中,核磁共振扫描主要是3D-T1像和静息态核磁共振的扫描。数据采用Matlab、spm8、 DPARSF、REST和SPSS软件进行统计分析。结果：1)帕金森患者治疗后UPDRS量表评分为22.67±12.686,较治疗前明显降低,且差异有统计学意义(t=0.04,P0.05)；2)运动迟缓项目评分明显下降,且差异有统计学意义(t=0.035,P0.05)；震颤和僵直项目评分治疗前后无差异；3)动词流畅性任务成绩治疗前后无差异；4)与治疗前相比较,治疗后右侧壳核与SMA功能连接增强；5)与治疗前相比较治疗后左测壳核与小脑功能连接增强。结论：5Hz的重复经颅磁刺激可能有效的改善帕金森患者的运动症状,尤其是运动迟缓。但对震颤和僵直没有影响。另外,动词流畅性成绩前后没有明显改变。从静息态功能核磁共振结果可以看出,重复经颅磁刺激通过增强辅助运动区-壳核之间的功能连接可能对患者的运动迟缓症状有改善作用。
[Abstract]:Background: Parkinson's disease, also known as the primary, is a neurodegenerative disease in the middle-and-old-age group. The prevalence of parkinson's disease is 1000/ 100,000 in the population over the age of 60 and increases with age. In our country, with the age of aging, the patients with parkinson's disease have increased significantly. The traditional medicine treatment not only brings great side effects to the patients, but also the drug effect gradually decreases and even does not work. The treatment of functional neurosurgery and the presence of deep brain stimulation in the treatment of parkinson's disease lead to the dawn of the disease, but these invasive methods of treatment and their expensive costs are prohibitive for most patients. Since the advent of repeated transcranial magnetic stimulation, the study and treatment of various clinical diseases have been continuously used. The present study shows that the repeated transcranial magnetic stimulation has a good therapeutic effect on Parkinson's disease, and most of the studies have selected a region as a treatment site. Objective: To observe whether the treatment of the auxiliary moving area with repeated cranial magnetic stimulation (5Hz) can improve the patient's movement symptoms and the effect on the function of the brain. Methods: The single-sample design was used. The baseline level of the patient was assessed by the VRS scale, the MMSE scale, and the speech fluency test in accordance with the diagnostic criteria and the measurement criteria for 9 patients with Parkinson's disease, and the rest-state nuclear magnetic resonance data was received; then, the patient was asked to start repeating the cranial magnetic stimulation treatment after 2 hours of dosing, The treatment parameters were 5Hz/ 100% RMT/ 1600 pulse stimulation, the treatment site was in the auxiliary motion area for 2 weeks, 5 times a week, 10 times a week, and the treatment was re-evaluated and nuclear magnetic resonance scanning after the treatment was completed. in which, the nuclear magnetic resonance scanning is mainly the scanning of the 3D-T1 image and the resting state nuclear magnetic resonance. The data were analyzed by Matlab, spm8, DPARSF, REST and SPSS. Results: 1) The score of the post-treatment RRS scale in the patients with Parkinson's disease was 22. 67 and 12. 686, which was significantly lower than that before treatment (t = 0. 04, P <0.05), and the score of the motor-delayed project was significantly lower, and the difference was statistically significant (t = 0.035, P0.05); There was no difference before and after the treatment of tremors and stiffness. (3) There was no difference before and after the operation of the fluency task of the verb; 4) Compared with the pre-treatment, the right case core and the SMA functional connection were enhanced after the treatment; and 5) the connection between the core of the left test case and the cerebellar function was enhanced after the treatment before the treatment. Conclusion: The repeated transcranial magnetic stimulation of 5Hz may be effective in the improvement of the motor symptoms of Parkinson's disease, especially the slow motion. But there's no effect on tremors and rigor. in addition, there was no obvious change before and aft that fluency of the verb. It can be seen from the results of a resting-state nuclear magnetic resonance that the repeated transcranial magnetic stimulation may have an improved effect on the patient's bradykinesia by enhancing the functional connection between the auxiliary moving region and the shell core.
【学位授予单位】：杭州师范大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R742.5

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