基于磁共振引导下的经颅磁对卒中后抑郁患者的疗效

Efficacy of TMS coil positioning over premotor and prefrontal targets based on MRI in patients with chronic pain and depression

目的观察基于磁共振定位的重复经颅磁刺激治疗卒中后抑郁患者的疗效是否优于常规定位下的刺激。方法将60例卒中后抑郁患者随机分为3组各20例,3组患者在常规训练的基础上给予经颅磁干预;A组患者给予假刺激治疗,B组给予常规定位下经颅磁治疗,C组给予磁共振引导下的经颅磁治疗,于治疗前和治疗4周后进行评估。治疗前后用蒙哥马利抑郁评定量表(MADRS)和汉密尔顿抑郁量表(HAMD)进行精神心理评定,以蒙特利尔认知评估量表(MoCA)行认知功能评定,用改良Barthel指数(MBI)量表进行日常生活活动能力评定。结果治疗前3组患者各项评分无统计学差异(P>0.05);治疗4周,3组患者评分均较前明显较低,组间比较,B组治疗后MADRS、HAMD、MBI以及MoCA评分分别为(18.65±1.89)分、(20.55±2.53)分、(53.15±2.89)分、(21.25±2.89)分较A组(20.00±1.95)分、(22.10±2.08)分、(51.20±2.95)分、(19.15±3.23)分,差异有统计学意义(P<0.05),C组治疗后MADRS、HAMD、MBI以及MoCA评分分别为(15.75±3.14)分、(17.45±3.90)分、(58.50±3.30)分、(25.40±3.32)分与B组比较(18.65±1.89)分、(20.55±2.53)分、(53.15±2.89)分、(21.25±2.89)分,差异有统计学意义(P<0.01)。结论rTMS能进一步缓解PSD患者的抑郁情绪,提高生活质量、改善认知功能,给予经颅磁定位的rTMS相对于常规组效果更加显著。

Objective To investigate whether MRI-guided coil positioning is superior to standard 5-cm method in the efficacy when repetitive transcranial magnetic stimulation(rTMS)on patients with post-stroke depression(PSD).Methods According to the different treatment methods,60 patients who meet the standards were randomly assigned to 3 groups(20 cases each).The patients in group A were treated with ineffective repetitive transcranial magnetic stimulation,those in group B were given repetitive transcranial magnetic stimulation with standard 5-cm method positioning,and those in group C were subjected to repetitive transcranial magnetic stimulation with MRI-guided coil positioning.Patients were evaluated with scores of Hamilton depression(HAMD),Montgomery-Asberg depression rating scale(MADRS),modified Barthel index(MBI)and Montreal cognitive assessment(MoCA)before and after treatment.Results There were no significant differences in all index among the three groups before treatment(P>0.05).After 4 weeks of treatment,the HAMD and MARDS in the three groups was significantly lower than that before treatment(P<0.05),the MoCA and MBI was significantly higher than that before treatment.The MADRS,HAMD,MBI and MoCA of the B group were 18.65±1.89,20.55±2.53,53.15±2.89,21.25±2.89,respectively;the HADRS,HAMD,MBI and MoCA of the A group were 20.00±1.95,22.10±2.08,51.20±2.95,19.15±3.23,respectively;the HADRS,HAMD,MBI and MoCA of the C group were 15.75±3.14,17.45±3.90,58.50±3.30,25.40±3.32;those in group B were superior to group A.Moreover,the group C of which were better than the B group at the end of the fourth week of treatment(P<0.01).Conclusion The rTMS is safe and effective in the treatment of PSD.It is obviously that MRI-guided coil positioning is better than standard 5 cm method in improving PSD and daily life ability after four weeks of treatment.