高频重复经颅磁刺激对帕金森病患者情绪障碍及P300电位的影响

Effects of high frequency repetitive transcranial magnetic stimulation on emotional disorders and P300 of patients with Parkinson's disease

研究背景以往研究显示高频重复经颅磁刺激可以明显改善帕金森病患者运动功能,但帕金森病晚期非运动性症状给患者带来更为严重的影响,因此研究高频重复经颅磁刺激治疗帕金森病患者情绪和认知功能障碍等非运动性症状的临床疗效具有重要意义。方法共纳入65例诊断明确的帕金森病患者,根据统一帕金森病评价量表(UPDRS)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和P300波,评价高频重复经颅磁刺激对患者精神行为和情绪、日常生活活动能力及运动功能的改善作用。结果与治疗前相比,帕金森病患者UPDRS总评分(t=10.872,P=0.000)和UPDRSⅠ(t=4.538,P=0.023)、UPDRSⅡ(t=8.846,P=0.012)、UPDRSⅢ(t=9.114,P=0.000)评分降低。患者焦虑和抑郁发生率由治疗前的52.46%(32/61)降至29.51%(18/61),认知功能障碍发生率由治疗前的42.62%(26/61)降至32.79%(20/61),HAMA(t=3.692,P=0.000)和HAMD(t=4.241,P=0.000)评分显著降低,但幻觉发生率由治疗前的18.03%(11/61)升至29.51%(18/61)。P300波潜伏期(t=5.924,P=0.000)和波幅(t=8.512,P=0.000)与治疗前比较,差异均有统计学意义。结论高频重复经颅磁刺激能够减轻帕金森病患者焦虑和抑郁状态,改善其认知功能。

Background Previous studies revealed that repetitive transcranial magnetic stimulation （rTMS） can obviously improve the motor function of Parkinson＇s disease （PD） patients. Since the non-motor symptoms of late stage PD can induce worse impacts on patients, it is important to investigate the clinical effects of high frequency rTMS on non-motor symptoms including emotional and cognitive disorders of PD patients. Methods Sixty-five patients with PD received rTMS therapy. Unified Parkinson＇s Disease Rating Scale （UPDRS）, Hamilton Anxiety Scale （HAMA）, Hamilton Depression Scale （HAMD） and P300 before and after treatment were recorded to assess the effect of rTMS on patient＇s emotions, abilities of daily living and motor functions. Results After treatment, the total UPDRS （t = 10.872, P = 0.000）, UPDRS I （t = 4.538, P = 0.023）, UPDRS l] （t = 8.846, P = 0.012） and UPDRS ]ff scores （t = 9.114, P = 0.000） were all significantly decreased. The incidence rate of depression and anxiety was reduced from 52.46% （32/61） to 29.51% （18/61）, and cognitive disorder from 42.62% （26/61） to 32.79% （20/61）. HAMA （t = 3.692, P = 0.000） and HAMD （t = 4.241, P = 0.000） scores were significantly reduced, but hallucinogenesis was increased from 18.03% （11/61） to 29.51% （18/61）. The incubation period of P300 was significantly reduced （t = 5.924, P = 0.000）, but the amplitude was increased （t = 8.512, P--0.000）. Conclusion High frequency rTMS can reduce anxiety and depression, and improve cognition of PD patients.