经颅直流电刺激对帕金森病患者平衡功能的影响

Effect on Balance Function in Patients with Parkinson’s Disease Treated by Transcranial Direct Current Stimulation

目的:观察经颅直流电刺激(tDCS)对帕金森病患者平衡功能的影响。方法:采用双盲、随机、对照研究的方法,利用SPSS20.0统计软件中随机数字生成器对符合入选标准的49例帕金森病患者进行分组,分为干预组25例和对照组24例。2组在常规药物和康复治疗的基础上,分别给予tDCS治疗和安慰tDCS治疗,tDCS阳极电极置于左侧背外侧前额叶皮层,阴极电极置于右侧眶前额叶,2组分别接受20min/d、连续5d的治疗,治疗时干预组电流为2mA,而对照组作为安慰治疗,仅在治疗起始和结束前30s电流为2mA,其他时间电流为0mA。在治疗前和治疗5d后,应用Berg平衡量表(BBS)、NeuroCom平衡系统(参数包括6种不同条件下的平衡测评值)进行测评。结果:2组治疗前BBS评分、NeuroCom平衡系统中6种平衡条件下的平衡结果测评值比较,差异无统计学意义(P>0.05)。治疗5d后,干预组BBS评分为(52.24±4.04)分,较治疗前(50.44±4.89)分有改善,差异有统计学意义(P<0.05);对照组BBS评分为(51.96±4.11)分,较治疗前(49.75±4.74)分有改善,差异有统计学意义(P<0.05);2组治疗后BBS评分比较,差异无统计学意义(P>0.05)。治疗5d后,干预组NeuroCom平衡系统平衡条件①、②、③和⑤下的测评值与治疗前比较,差异无统计学意义(P>0.05),而NeuroCom平衡系统平衡条件④和⑥下的测评值分别为(73.21±8.89)分和(37.42±26.46)分,优于治疗前(64.72±13.93)分和(31.09±29.28)分,差异有统计学意义(P<0.05);对照组NeuroCom平衡系统平衡条件①、②、③、④、⑤和⑥下的测评值与治疗前比较,差异均无统计学意义(P>0.05)。结论:tDCS可增强帕金森病患者的视空间处理能力和前庭功能,从而提高其平衡能力。

Objective: To observe the improvement of balance function in patients with Parkinson’s disease treated by transcranial direct current stimulation(tDCS). Methods: With double-blind, random and control studies, using the random number generator in SPSS 20.0 statistical software, a total of 49 patients with Parkinson’s disease who met the inclusion criteria were divided into intervention group(n=25) and control group(n=24). In addition to the routine treatment, both of groups were given the treatment of t DCS respectively. Anode electrode of t DCS was placed over the left dorsolateral prefrontal cortex, and cathode electrode of t DCS was placed over the right orbital frontal cortex. Two groups were treated once a day, 20 min per time, and for 5 consecutive days. The difference between two groups was that the current intensity of the intervention group was 2 m A, while acting as a placebo condition, the current intensity of the control group was 2 m A only at the first and last 30 s during the treatment, the rest of time was 0 m A. Before and after 5 days, patients with Parkinson’s disease were evaluated by scales in terms of Berg Balance Scale(BBS) and NeuroCom Balance system(parameters including scores of balance test under six conditions). Results: Before treatment, there was no statistically significant difference between the two groups on BBS scores and the balance results of the 6 kinds of balance conditions in the NeuroCom Balance system(P>0.05). After five days’ treatment, BBS scores(52.24±4.04) of the intervention group were improved compared with those(50.44± 4.89) before treatment, and the difference was statistically significant(P<0.05);the BBS scores(51.96± 4.11) of the control group were improved compared with those(49.75±4.74) before treatment, and the difference was statistically significant(P<0.05);there was not statistically significant in the BBS scores after treatment between the two groups(P>0.05). After five days’ treatment,the evaluation values of NeuroCom Balance system of condition ①, ②, ③ and ⑤ in the intervention group were not statistically significant(P>0.05);the evaluation values of NeuroCom Balance system of condition ④(73.21±8.89) and ⑥(37.42±26.46) in the intervention group were statistically significant than before(64.72±13.93) and(31.09±29.28)(P<0.05). The evaluation values of NeuroCom Balance system of condition ①, ②, ③, ④, ⑤ and ⑥ in the control group were not statistically significant(P>0.05). Conclusion:t DCS could enhance the visual spatial processing and vestibular function in patients with Parkinson’s disease and improve the ability with their balance.