高频重复经颅磁刺激治疗原发性三叉神经痛的临床研究

High-frequency repetitive transcranial magnetic stimulation in patients with primary trigeminal neuralgia

目的评价高频重复经颅磁刺激(hrTMS)治疗原发性三叉神经痛患者的疗效和安全性。方法选择安徽医科大学附属安庆医院神经内科病房及门诊自2015年12月至2018年10月收治的原发性三叉神经痛患者38例,按患者意愿将其分为hrTMS治疗组和对照组,每组19例。hrTMS治疗组患者给予20HzhrTMS治疗,对照组患者给予伪磁刺激治疗。比较2组患者治疗前、治疗后1周、2周、4周视觉模拟评分(VAS),治疗后1周、2周、4周巴罗神经病学研究所(BNI)疼痛评分、诱发电位N100波幅及不良反应的发生情况。结果治疗后2周、4周hrTMS治疗组患者VAS评分低于对照组,差异均有统计学意义(P<0.05);hrTMS治疗组患者治疗后2周、4周VAS评分低于治疗前和治疗后1周,且治疗后4周VAS评分低于治疗后2周,差异均有统计学意义(P<0.05)。治疗后2周、4周hrTMS治疗组患者BNI疼痛评分低于对照组,N100波幅高于对照组,差异均有统计学意义(P<0.05);hrTMS治疗组患者治疗后1周、2周、4周BNI疼痛评分逐渐降低,N100波幅逐渐增高,差异均有统计学意义(P<0.05)。对照组和hrTMS治疗组患者治疗后头痛(10.53%vs.21.05%)和头部不适(36.84%vs.26.32%)发生率差异均无统计学意义(P>0.05)。结论hrTMS能够有效地缓解原发性三叉神经痛患者的疼痛程度,且安全可靠。

Objective To explore the efficacy and safety of high-frequency repetitive transcranial magnetic stimulation (hrTMS) in treatment of patients with primary trigeminal neuralgia. Methods Thirty-eight patients with primary trigeminal neuralgia were divided into hrTMS treatment group and control group (n=19) according to the willing of the patients;patients in the hrTMS treatment group were treated with 20 Hz hrTMS;those in the control group were given placebo-controlled transcranial magnetic stimulation. The visual analogue scale (VAS) scores one week before, and one, two and 4 weeks after treatment were compared between the two groups. Scores of pain scale of Barrow Neurologic Institute (BNI), evoked potential (N100) amplitude and incidence of adverse reactions one, two and 4 weeks after treatment were compared between the two groups. Results VAS scores in the hrTMS treatment group two and 4 weeks after treatment were significantly lower as compared with those in the control group (P<0.05). In patients from the hrTMS treatment group, VAS scores two and 4 weeks after treatment were significantly lower than those one week before and one week after treatment (P<0.05);and those 4 weeks after treatment were significantly lower than those two weeks after treatment (P<0.05). Patients from the hrTMS treatment group two and 4 weeks after treatment had significantly lower BNI scores and statistically higher N100 amplitude as compared with those in the control group (P<0.05). In the hrTMS treatment group, BNI scores gradually decreased and N100 amplitude gradually increased one, two and 4 weeks after treatment, with statistically significant differences between each two time points (P<0.05). There were no significant differences in the incidence of headache (10.53% vs. 21.05%) and head discomfort (36.84% vs. 26.32%) after treatment between the two groups (P>0.05). Conclusion The hrTMS can effectively alleviate pain of primary trigeminal neuralgia, and it is safe and reliable.