低频重复经颅磁刺激治疗帕金森病伴中重度不宁腿综合征患者的临床效果分析

Effect of low frequency repetitive transcranial magnetic stimulation on Parkinson disease with moderate to severe restless legs syndrome

目的分析低频重复经颅磁刺激（rTMS）治疗帕金森病伴中重度不宁腿综合征（RLS）患者的临床效果。方法选择2015年1-10月在第四军医大学第二附属医院（唐都医院）神经内科住院的原发性帕金森病伴中重度RLS患者42例，采用随机数字表法分为rTMS组和对照组，各21例。rTMS组采取低频rTMS＋多巴丝肼片＋普拉克索治疗，选取右侧额叶皮质前区为刺激点，给予5Hz低频脉冲刺激；对照组采取伪线圈rTMS＋多巴丝肼片＋普拉克索治疗，给予相同部位、相同频率伪线圈刺激。刺激强度为80％运动阈值，刺激时间8s，间隔时间4s，连续刺激100次，每天固定时间治疗1次，每次20min，连续治疗10d。于治疗前及治疗后第10、20天，采用RLS病情严重程度评定量表（RLSRS）、统一帕金森病评分量表（UPDRS）、匹兹堡睡眠质量指数量表（PSQI）对2组患者进行疗效评价，通过多导睡眠监测记录相关参数的变化。结果rTMS组治疗后第10、20天的RLSRS、UPDRS、PSQI评分明显低于治疗前[（15．5±2．1）、（13．1±2．3）分比（21．7±2．9）分，（47±7）、（40±6）分比（52±9）分，（11．2±2．3）、（6．7±1．8）分比（18．2±2．7）分]（P〈0．05）；治疗后第20天的RLSRS、PSQI评分明显低于对照组[（17．7±2．5）分、（13．4±2．1）分]（P〈0．01）。rTMS组治疗后第10、20天的睡眠效率、睡眠维持率明显高于治疗前，觉醒次数明显少于治疗前[（84．8±5．1）％、（92．84-3．3）％比（77．3±6．6）％，（85．1±5．2）％、（93．1±4．2）％比（72．5±5．8）％，（8．2±2．9）、（5．1±2．5）次比（18．2±3．3）次]（P〈0．05）；治疗后第20天的睡眠效率、睡眠维持率明显高于对照组[（82．1±4．2）％、（84．2±3．8）％]，觉醒次数明显少于对照组[（13．3±2．7）次]（P〈0．01）。结论低频rTMS治疗帕金森病伴中重度RLS的临床效果明显。

Objective To analyze the clinical effect of low frequency repetitive transcranial magnetic stimulation（rTMS） on moderate to severe restless legs syndrome （RLS） in patients with Parkinson disease. Methods A total of 42 Parkinson disease patients with moderate to severe RLS from January to October 2015 in the Second Affiliated Hospital of the Fourth Military Medical University （ Tangdu Hospital） were randomly divided into rTMS group and control group, with 21 cases in each group. The rTMS group had low frequency rTMS ＋ mado- par ＋ pramipexole ; the control group had pseudo-rTMS ＋ madopar ＋ pramipexole ; 5 Hz pulse stimulation was given to rTMS group at cortex of right frontal lobe; 5 Hz pseudo-stimulation was given to control group at the same site （80% motor threshold, 8 s stimulation duration with 4 s intervals, 100 times of continuous stimulation, 1 time/d, 20 min/time, sum to 10 d）. The RLS Rating Scale（ RLSRS）, Unified Parkinson Disease Rating Scale（UPDRS） and Pittsburgh Sleep Quality Index（PSQI） were evaluated before treatment and on the 10th, 20th day after treat- ment. Sleep parameters were recorded by polysomnography. Results RLSRS, UPDRS, PSQI scores on the lOth, 20th day after treatment were significantly lower than those before treatment in rTMS group [ （ 15.5 ± 2. 1 ）, （ 13.1 ± 2. 3） scores vs （ 21.7± 2. 9 ） scores ; （ 47 ± 7 ）, （ 40 ± 6 ） scores vs （ 52 ± 9 ） scores ; （ 11.2 ± 2. 3 ）, （6.7 ±1.8） scores vs （ 18. 2 ±2.7） scores] （P 〈0. 05） ; RLSRS and PSQI scores on the 20th day after treatment in rTMS group were significantly lower than those in control group [ （ 17.7 ±2. 5 ） scores, （ 13.4 ±2. 1 ） scores ] （P 〈 0. 01 ）. Sleep efficiency and sleep maintenance on the 10th, 20th day after treatment were significantly higher and awakening times was significantly lower than those before treatment in rTMS group [ （84. 8 ±5.1 ）%, （92. 8 ± 3.3）% vs （77.3±6.6）%; （85.1 ±5.2）%,（93.1 ±4.2）% vs （72.5 ±5.8）%; （8.2 ±2.9）,（5.1 ±2. 5 ） times vs （ 18.2 ± 3.3 ） times ] （ P 〈 0. 05 ） ; sleep efficiency and sleep maintenance on the 20th day in rTMS group were significantly higher and awakening times was significantly lower than those in control group [ （82. 1 ±4.2）%,（84.2±3.8）%,（13.3±2.7）times]（P〈0.01）. Conclusion Low frequency rTMS is effective in treating moderate to severe RLS in Parkinson disease.