三重刺激技术定量评价多系统萎缩患者重复经颅磁刺激治疗效果二例分析

Triple stimulation technique to evaluate the curative effect of repetitive transcranial magnetic stimulation in patients with multiple system atrophy: two cases report

研究背景既往研究显示,初级运动皮质予重复经颅磁刺激可以改善皮质脊髓束损害。本研究采用三重刺激技术定量评价2例以帕金森综合征为主要表现的多系统萎缩(MSA-P)患者重复经颅磁刺激前后皮质脊髓束功能变化,探讨重复经颅磁刺激对皮质脊髓束损害的改善作用。方法 2例MSA-P型患者(1例为62岁男性,1例为44岁女性),病程1年,均接受重复经颅磁刺激,采用小指展肌三重刺激技术波幅比和统一多系统萎缩评价量表第二部分(UMSARSⅡ)评价治疗前后皮质脊髓束功能和运动功能。结果 2例MSA-P型患者治疗前小指展肌三重刺激技术波幅比为28.30%和69.10%,UMSARSⅡ评分22和20分;治疗后即刻小指展肌三重刺激技术波幅比为58.40%和71.70%,UMSARSⅡ评分16和12分,其中例1随访至重复经颅磁刺激后2个月,治疗后1和2个月小指展肌三重刺激技术波幅比分别为90.70%和50.70%,UMSARSⅡ评分17和23分。结论采用三重刺激技术可以定量评价重复经颅磁刺激对MSA-P型患者皮质脊髓束损害的改善作用。

Background Previous studies suggest that the cortico-spinal tract can be modulated by M1 repetitive transeranial magnetic stimulation （rTMS）. However, it is not well investigated in patients with multiple system atrophy （MSA）. We discuss 2 cases of MSA with parkinsonism-predominant （MSA-P）, who have been evaluated the function of cortico-spinal tract using triple stimulation technique （TST） before and after rTMS, so as to explore the effect of rTMS on improving the damage of eortico-spinal tract. Methods Two MSA-P patients （one 62-year-old male, one 44-year-old female） with disease course of one year were examined with TST at abductor digiti minimi. TST amplitude ratio and the motor score of Unified Multiple System Atrophy Rating Scale （UMSARS Ⅱ） were used to assess the damage of cortico-spinal tract and motor function before and after rTMS treatment. Results TST amplitude ratio at abductor drgiti minimi of both patients was 28.30% and 69.10%, and UMSARS Ⅱ score was 22 and 20 before treatment. Immediately after rTMS the amplitude ratio was 58.40% and 71.70%, and UMSARS Ⅱ score was i6 and 12, respectively. The improvement sustained in Case one in the next month （TST amplitude ratio 90.70%, UMSARS lI score 17） and the second month （TST amplitude ratio 50.70%, UMSARS 11 score 23）. Conclusions TST can be used to quantitatively evaluate the integrity of cortico-spinal tract after rTMS.