重复经颅磁刺激改善帕金森病运动症状的脑功能网络分析

Brain Functional Network Analysis of Repetitive Transcranial Magnetic Stimulation Therapy for Motor Symptoms in Parkinson’s disease

目的重复经颅磁刺激(rTMS)技术已广泛应用在临床中,实现对神经、精神类疾病的治疗,特别在抑郁症、强迫症中取得较好的临床治疗效果。近年来越来越多的研究将其应用于帕金森病(PD)的辅助、康复治疗,以期缓解患者的运动症状改善运动功能。目前临床中多以PD统一量表、运动任务评估rTMS对运动症状的辅助治疗效果,缺乏对高频rTMS刺激调控作用机制的探究。方法本研究采用10 Hz rTMS刺激肢体症状始发侧对侧初级运动皮层(M1),对比分析刺激前后各脑区神经元活动及其连接性的变化,研究高频r TMS刺激初级运动皮层对PD患者大脑神经元活动的调节作用。结果运动皮层beta振荡增加、gamma振荡降低(P<0.05),额、顶叶脑区间连接性减弱(P<0.05)。结论10 Hz rTMS主要改变了PD患者beta、gamma振荡,其中运动皮层beta、gamma神经振荡的变化可能与磁刺激对运动功能的改善作用有关,而前额叶gamma振荡的变化可能是磁刺激抑制神经元异常放电活动调节患者运动控制功能。

Objective Repetitive transcranial magnetic stimulation(rTMS) has been widely used in clinics to realize the treatment of neurological and psychiatric diseases, especially in depression and pain. In recent years, many studies have applied it as an adjuvant approach to treatment of Parkinson’ s disease(PD) in order to relieve the patient’ s motor symptoms and improve motor function. At present, the unified Parkinson’ s disease scale and motor task are used to evaluate the adjuvant treatment effect of rTMS on motor symptoms, but there are few studies exploring the regulatory mechanism of high-frequency rTMS stimulation. Methods In this study, 10 Hz rTMS over the primary motor cortex(M1) on the contralateral side of the limb symptom onset side in 16 PD patients. By comparing the changes of brain neuron activity and the interactions between brain function before and after stimulation, we investigated the regulatory effect of repeated sessions of M1 high-frequency rTMS on brain neuron activity in PD patients. Results The results showed that after 10 d of M1 stimulation, beta oscillations increased and gamma oscillation significantly decreased(P<0.05) in motor cortex, and the connectivity between the frontal and parietal cortex was reduced(P<0.05). Conclusion It shows that 10 Hz rTMS mainly changes the beta and gamma rhythm in PD patients. The changes of beta and gamma oscillations in motor cortex may be related to the improvement of motor function, and the changes in prefrontal gamma oscillations may be due to inhibits abnormal neuron firing activities and modulates the patient’ s motor control function.