高频 重复经颅磁刺激对卒中后抑郁和运动功能的影响

EFFECTS OF HIGH-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION ON POST-STROKE DEPRESSION AND MOTOR FUNCTION

目的探讨不同频率高频重复经颅磁刺激(rTMS)对卒中后抑郁(PSD)病人抑郁症状及肢体运动功能的影响。方法将PSD病人42例随机分为5 Hz组(13例)、10 Hz组(14例)以及对照组(15例),分别给予5、10 Hz的rTMS及假刺激,每次20 min,每周5次,连续3周。各组分别于治疗前后行汉密尔顿24项抑郁量表(HDRS-24)、Fugl-Meyer运动评估量表(FMA)、改良Barthel指数(MBI)和运动诱发电位(MEP)潜伏期评定。结果 与治疗前比较,治疗后5 Hz组及10 Hz组病人HDRS-24评分、FMA评分、MBI评分和MEP潜伏期均有所改善,差异有统计学意义(t=6.01~16.30,P<0.05)。与对照组比较,治疗后5 Hz组、10 Hz组病人HDRS-24评分和MEP潜伏期均有改善,差异有统计学意义(F=11.61、5.59,P<0.05);FMA评分、MBI评分差异无统计学意义(P>0.05)。10 Hz组与5 Hz组HDRS-24评分、FMA评分、BMI评分和MEP潜伏期比较差异均无统计学意义(P>0.05)。结论 高频rTMS治疗后PSD病人抑郁症状有改善,但5与10 Hz的rTMS对抑郁症状及运动功能的改善作用无明显差异。

ObjectiveTo investigate the effects of high-frequency repetitive transcranial magnetic stimulation(rTMS)at different frequencies on depressive symptoms and limb motor function in patients with post-stroke depression(PSD).Methods Forty-two patients with PSD were randomly divided into 5 Hz group(13 cases),10 Hz group(14 cases),and control group(15 cases);the three groups were subjected to 5 Hz rTMS,10 Hz rTMS,and pseudo-stimulation,respectively,for 3 consecutive weeks(5 sessions/week,20 min/session).Before and after treatment,each group underwent the following assessments:Hamilton Depression Rating Scale-24(HDRS-24),Fugl-Meyer Assessment(FMA),Modified Barthel Index(MBI),and Motor Evoked Potential(MEP)latency.ResultsAfter treatment,the patients in the 5 Hz and 10 Hz groups had significantly improved HDRS-24 score,FMA score,MBI score,and MEP latency(t=6.01-16.30,P<0.05).Compared with the control group,the 5 Hz and 10 Hz groups had significantly improved HDRS-24 score and MEP latency(F=11.61,5.59;P<0.05),but had no significant changes in FMA and MBI scores(P>0.05).There were no significant differences in HDRS-24 score,FMA score,BMI score,and MEP latency between the 10 Hz group and the 5 Hz group(P>0.05).ConclusionThe depressive symptoms of patients with PSD are improved after treatment with high-frequency rTMS,but 5 Hz and 10 Hz stimulations are not significantly different in improving depressive symptoms and motor function.