低频重复经颅磁刺激对帕金森病患者运动功能及皮质兴奋性的影响

Effects of low frequency repetitive transcranial magnetic stimulation on motor function and excitability of motor cortex in patients with Parkinson＇s disease

目的从运动功能、电生理检测方面观察低频重复经颅磁刺激（rTMS）对帕金森病（PD）患者的治疗作用，并从电生理角度进一步探索PD的发病机制。方法采用低频rTMS技术治疗28例PD患者（患者组），刺激部位为人选者双侧的第一运动皮质手代表区MIHand，频率为1Hz，磁场强度为120％静息阈值，每日1次，共15d。另选择30名健康者作为对照组。采用统一帕金森病评定量表（UPDRS）评分、运动诱发电位（MEP）作为评定指标。结果PD患者MEP的静息态阈值（RMT）、中枢传导时间（CMCT）明显低于对照组，而波幅（Amp）比较，差异无统计学意义。经rTMS治疗后，PD患者运动功能有改善，RMT增加．CMCT延长，强直型患者症状改善更为明显。结论PD患者存在运动功能障碍，大脑皮质兴奋性提高，低频rTMS可部分抑制这种改变。

Objective To investigate the effects of low frequency repetitive transcranial magnetic stimulation （rTMS） on motor function and excitability of motor cortex in Parkinson＇s disease （PD） patients and to study the mechanism of PD from the electrophysiology. Methods Twenty-eight patients with PD received 1 Hz rTMS therapy for 15 d. Thirty normal volunteers were enrolled as controls. Unified Parkinson＇s Disease Rating Scale （UPDRS） and motor evoked potential （MEP） were adopted as assessment indicators. The excitability of motor cortex was assessed by rest motor threshold （RMT）, central motor conduction time （CMCT） and the amplitude of MEP. Results The initial RMTs and CMCTs of PD patients were significantly lower than those of the controls, but MEP amplitudes were not significantly different. After rTMS treatment, motor function of PD patients improved, RMTs increased and CMCTs prolonged. Conclusion In PD patients, motor function disorder and increased motor cortical excitability were observed. Low frequency rTMS may inhibit these changes to some extent.