重复经颅磁刺激辅助运动区对帕金森病患者运动皮质兴奋性的影响

The effects of repetitive transcranial magnetic stimulation of the supplementary motor area on the excitability of motor cortex in patients with Parkinson＇s disease

目的探讨重复经颅磁刺激（rTMS）辅助运动区对帕金森病（PD）患者运动皮质兴奋性的影响。方法选择16例PD患者，重复经颅磁刺激其辅助运动区，频率为5Hz，共1200次脉冲，磁刺激强度为100％静息阈值（RMT）。于干预前30min及干预后不同时间点分别检测其运动诱发电位及体感诱发电位成分N30等指标。结果重复经颅磁刺激后10min，P20～N30波幅较刺激前显著增高（P〈0．05），同时P／F指数显著减低（P〈0．05）；运动诱发电位（MEP120）波幅显著增高，且在刺激后10min达到峰值。结论频率为5Hz的重复经颅磁刺激辅助运动区，不仅可暂时改善辅助运动区局部的兴奋性，还可影响与之存在纤维联系的第一躯体运动区的兴奋性。

Objective To study the effects of repetitive transcranial magnetic stimulation （rTMS） of the supplementary motor area （SMA） on the cortical excitability in patients with Parkinson＇s disease （ PD）. Methods Sixteen patients with PD were included in this study. The motor evoked potentials （MEP） and the N30 component of somatosensory evoked potentials （SEP） were assessed for each patient before and after 1200 pulses of rTMS of the SMA at 5 Hz and an intensity of 100% of relaxed motor threshold （RMT） for the abductor pollieis brevis. Results Ten minutes after the rTMS intervention, the peak-to-peak amplitude of the SEP component P20-N30 increased significantly （ P 〈 0.05 ） , with the P/F index decreased simultaneously （ P 〈 0.05 ）. The MEP amplitude increased significantly, and reached the highest value at 10min after the rTMS intervention. Conclusion 5 Hz rTMS of the SMA can improve the excitability of the SMA itself temporarily. Meanwhile, it can induce a short-lasting facilitation of the excitability of M1 connected with SMA.