高低频率重复经颅磁刺激对脑外伤后认知功能影响的随机对照研究

Effect of repetitive transcranial magnetic stimulation with high and low frequency on cognition after traumatic brain injury

目的:观察高低频率重复经颅磁刺激(rTMS)对脑外伤(TBI)患者认知功能的影响。方法:60例脑外伤后认知功能下降的患者随机分成高频刺激组、低频刺激组及对照组各20例,3组均进行常规治疗,并分别给予高频rTMS(10Hz)、低频率rTMS(1Hz)、伪刺激,共治疗4周。治疗前后分别采用蒙特利尔认知量表(MoCA)、洛文斯顿认知成套测验(LOTCA)及事件相关电位P300的潜伏期和波幅对患者进行评定。结果:治疗4周后,3组MoCA和LOTCA评分较治疗前均明显提高(均P<0.05),高、低频磁刺激组2项评分均高于对照组(均P<0.05),且高频磁刺激组2项评分高于低频磁刺激组(均P<0.05)。3组与治疗前比较,P300潜伏期均明显缩短(均P<0.05),波幅均明显升高(均P<0.05);高、低频磁刺激组与对照组比较,P300潜伏期均明显缩短(均P<0.05),波幅均明显升高(均P<0.05);高频磁刺激组P300潜伏期较低频磁刺激明显缩短(P<0.05)。结论:高频和低频重复经颅磁刺激均能改善脑外伤后患者的认知功能,且高频重复经颅磁刺激效果优于低频重复经颅磁刺激。

Objective:To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)with high and low frequency on cognitive impairment in patients with traumatic brain injury.Methods:Sixty patients with cognitive impairments after traumatic brain injury were randomly divided into high frequency rTMS group,low frequency rTMS group and control group,20 cases in each group.All 3 groups received routine treatment.On this basis,high frequency rTMS group,low frequency rTMS group and control group were given high frequency rTMS(10 Hz),low frequency rTMS(1 Hz)and sham stimulation respectively for 4 weeks.Patients were assessed by Montreal cognitive scale(MoCA),Loewenstein Occupational Therapy Cognitive Assessment(LOTCA)and the latency and amplitude of event-related potential P300 before and 4 weeks after treatment.Results:The scores of MoCA,and LOTCA were significantly increased after treatment for 4 weeks in each group(all P<0.05),and significantly higher in high frequency rTMS group,low frequency rTMS group than in control group(all P<0.05).The scores of MoCA and LOTCA were significantly increased in high frequency rTMS group than in low frequency rTMS group(both P<0.05).The latency of P300 was significantly shortened(all P<0.05),and the amplitude was obviously increased(all P<0.05)in three groups after treatment as compared with those before treatment.The latency of P300 was significantly shorter and the amplitude was significantly larger after treatment in the high and low frequency rTMS groups than those in the control group(both P<0.05).The latency of P300 after treatment in high frequency rTMS group was significantly shorter than that in low frequency rTMS group(P<0.05).Conclusion:High frequency rTMS and low frequency rTMS can significantly improve the cognitive functions in patients with traumatic brain injury,and the effect of high frequency stimulation is superior to that of low frequency stimulation.