低频重复经颅磁刺激治疗夜磨牙症的初步研究

Preliminary Study on Low-frequency Repetitive Transcranial Magnetic Stimulation to Patients With Sleep Bruxism

目的:观察低频重复经颅磁刺激方法治疗夜磨牙症的效果。方法:选择30名夜磨牙患者,先在正中矢状面旁9 cm、正中冠状面前4 cm左右,通过前后和左右的微移来确定最终能引起连续5个运动诱发电位的最小磁刺激强度所在的热点即hot spot,该最小磁刺激强度的值,即运动阈值(Active motor threshold,AMT)。然后在hot spot给予1 Hz(90%AMT)低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)进行治疗,左右每侧各20 min,共40 min,连续进行7 d。在治疗前两天和治疗后,给患者佩戴夜磨牙检测垫观察牙齿磨动的情况;同时对患者的咬肌浅、深层及颞肌前、中、后份进行触诊,让患者对触诊疼痛的程度进行评分。结果:治疗前,夜磨牙检测片上色素被磨除区域的面积、咬肌浅、深层,颞肌前、中、后份的触诊疼痛评分均无统计学差异。经过7 d低频rTMS治疗后,夜磨牙检测垫上色素被磨除区域的面积、咬肌浅、深层,颞肌前份的评分均显著下降( P <0.05);颞肌中、后份的评分无显著改变。结论:低频rTMS可以减少夜磨事件的发生,对夜磨牙症有治疗作用,可以在临床推广使用。

Objective: To evaluate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on patients with sleep bruxism. Methods: 30 patients with sleep bruxism participated in this study.The hot spot was defined at the spot where the AMT was elicited by the minimum stimulus intensity produced five discrete MEPs clearly.The active motor threshold was defined by the minimum stimulus intensity.The low-frequency rTMS was given at the hot spot using 90%AMT with 20 minutes on each side for a total of 40 minutes,for 7 consecutive days.Two days before and after the treatment,the patients were asked to ware a very thin splint made by Bruxchecker at night.Meanwhile,muscle palpation of the superficial and deep masseter muscle,and the anterior,middle and posterior portions of the temporalis was performed,and the scores of the evaluation of palpation given by the patients themselves were recorded. Results: Before the treatment,there was no statistically significant difference in the area of abrasion on the surface of the Bruxchecker and the scores of all muscle palpation.After 7 days of low-frequency rTMS treatment,the area of abrasion on the surface of the Bruxchecker was decreased ( P <0.05).The scores of superficial and deep masseter,and the anterior portionof the temporalis were all significantly decreased ( P <0.05).There was no significant change in the scores of the middle and posterior portions of the temporalis. Conclusion: The treatment by the low-frequency rTMS can reduce the incidence of bruxism and it is worthy of clinical application.