低频重复经颅磁刺激对脑卒中后抑郁状态和神经功能缺损的治疗效应

Evaluation of frequency repetitive transcranial magnetic stimulation for post-stroke depression and neurologic impairment

目的:探讨低频重复经颅磁刺激对脑卒中后抑郁患者抑郁状态和神经功能缺损的治疗效应。方法:脑卒中后抑郁患者32例为2002-01/2004-09华中科技大学同济医学院附属协和医院神经内科收治,所有患者脑卒中病程均>2个月,汉密顿抑郁量表(17项版本)评分均>17分,并排除既往有精神异常史者。32例患者随机抽签分为重复经颅磁刺激治疗组和对照组各16例,对照组仅给予常规治疗,重复经颅磁刺激治疗组在此基础上予以低频重复经颅磁刺激治疗,以60%最大刺激强度刺激双侧额叶,每侧刺激30次,频率0.5Hz,每日一序列,连续治疗7d。两组治疗期间均停用抗抑郁药物。于治疗前、后观察两组汉密顿抑郁量表评分及临床神经功能缺损程度评分的变化,以及两组患者抑郁症状改善率。结果:按意向处理分析,32例患者均完成了治疗,治疗期间无显著不适应现象。①重复经颅磁刺激治疗组平均汉密顿抑郁量表评分治疗后较治疗前明显降低(25.9±5.2,15.4±6.7),较对照组治疗后评分也明显降低(22.4±7.1),治疗组自身前后比较及治疗组与对照组治疗后比较差异均有显著性意义(t=4.97,3.43,P<0.01)。②重复经颅磁刺激治疗组临床神经功能缺损程度评分评分治疗后(12.6±4.6)较治疗前评分(18.3±4.8)明显降低(t=3.43,P<0.01),较对照组治疗后评分(16.6±4.7)也有所降低(t=2.43,P<0.05)。③重复经颅磁刺激治疗组治疗后抑郁症状改善有效率88%(14/16),对照组为12%(2/16)。两组有效率比较差异意义明显(χ2=31.64,P<0.01)。结论:0.5Hz低频重复经颅磁刺激可改善脑卒中后抑郁患者的抑郁症状,减轻患者的神经功能缺损程度,且患者无特殊不适应现象。

To assess the therapeutic effects of low frequency repetitive transcranial magnetic stimulation on the depressive state and degree of neurologic impairment in patients with post-stroke depression.METHODS： Thirty-two post-stroke depression patients, whose disease course of stroke was more than 2 months, and score of Hamilton depression scale （HAMD） was more than 17, were selected from the Department of Neurology, Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2002 to September 2004, and those with the history of mental abnormality were excluded. They were divided into repetitive transcranial magnetic stimulation treated group （n=16） and control group （n=16） with the method of random sampling. All the patients received regular treatment, besides, those in the repetitive transeranial magnetic stimulation treated group were treated with low frequency repetitive transcranial magnetic stimulation, each side of the prefrontal lobe was applied with 30 stimulations each day. The stimulation intensity is 60% of the maximum intensity, at 0.5 Hz. One sequence was given daily for 7 successive days. Antidepressant drugs were stopped during treatment in both groups. Before and after the repetitive transcranial magnetic stimulation treatment, the changes of Hamilton depression scale score and score of modified Scandinavian stroke scale for evaluation of clinical neurologic impairment degree, and the ameliorating rate of the depressive symptoms were observed in both groups.RESULTS： According to the analysis of intention process, All the 32 patients finished the treatment, and there was no maladaptation during treatment. ① In the repetitive transcranial magnetic stimulation treated group, the mean Hamilton depression scale score after treatment （15.4±6.7） was significantly lower than that before treatment（25.9±5.2） and that in the control group after treatment （22.4±7.1）（t=4.97, 3.43, P 〈 0.01）. ② The score of modified Scandinavian stroke scale in the repetitive transcranial magnetic stimulation treated group after treatment （12.6±4.6） was markedly decreased as compared with that before treatment （18.3±4.8） （t=3.43,P 〈 0.01） and that in the control group after treatment （16.6±4.7） （t=2.43, P 〈 0.05）. ③ There was significant difference in the effective ameliorating rate after treatment between the repetitive transcranial magnetic stimulation treated group（88%, 14/16） and control group （12%, 2/16） （x^2=31.64, P 〈 0.01）.CONCLUSION：Low frequency repetitive transcranial magnetic stimulation of 0.5 Hz can ameliorate the depressive symptoms of poststroke depression patients, and relive the degree of their neurologic impairment, and no special maladaptation occurs in the patients.