低频重复经颅磁刺激治疗眼睑痉挛的短期疗效观察

目的探讨低频重复经颅磁刺激(rTMS)治疗眼睑痉挛(BS)的短期疗效及安全性。方法纳入2019年11月至2020年7月眼睑痉挛患者共90例,根据随机数字表法分成三组,分别为低频重复经颅磁刺激组(rTMS组)、肉毒毒素组(BTX组)、肉毒毒素联合低频重复经颅磁刺激组(BTX+rTMS组)。分别给予三组不同的干预措施,随访12周,对比观察三组患者的起效时间,通过Jankovic评定量表(JRS)、眼睑痉挛残疾指数(BSDI)及改良TWSTRS疗效量表等综合评估疗效,并记录不良反应。结果rTMS组与BTX+rTMS组起效时间明显短于BTX组,差异有统计学意义(P<0.05)。三组患者在第1、4、12周JRS评分较治疗前均明显降低,差异有统计学意义(P<0.05)。第4、12周BTX组与BTX+rTMS组JRS评分均较rTMS组下降明显,差异有统计学意义(P<0.05)。第4、12周三组患者BSDI均较治疗前明显降低,差异有统计学意义(P<0.05)。第12周BTX组与BTX+rTMS组BSDI评分下降较rTMS组明显,差异有统计学意义(P<0.05)。第12周改良TWSTRS疗效评分≥3分者,BTX组7例(23.3%),BTX+rTMS组14例(46.67%),而rTMS组所有患者评分均<3分。结论眼睑痉挛经颅磁刺激治疗起效快,疗效维持时间短,不良反应少。低频rTMS联合肉毒毒素注射治疗能够缩短患者的起效时间,提高临床疗效。

Objective To assess the short-term effects and safety of low-frequency repetitive transcranial magnetic stimulation(rTMS)in the treatment of primary blepharospasm(BS).Methods A total of 90 BS patients who came to our neurologic clinic from November 2019 to July 2020 were selected,who were divided into three groups according to the random number table method,namely the botulinum toxin group(the BTX group),the low-frequency rTMS group(the rTMS group),the botulinum toxin combined with the low-frequency rTMS group(the BTX+rTMS group).The patients were followed up for 12 weeks after given different treatments.We recorded the onset time and the adverse reactions of the three groups.The Jankovic rating scale(JRS)and the blepharospasm disability index(BSDI)were used to evaluate the severity of the disease.And the modified Toronto Western Spasmodic Torticollis Rating Scale(TWSTRS)efficacy scale was used to evaluate the efficacy.Results The onset time of the rTMS group and the BTX+rTMS group was much shorter than that of the BTX group,and the difference was statistically significant(P<0.05).In the first,the fourth and the twelfth weeks,the JRS scores of the three groups were lower than those before treatment,and the difference was statistically significant(P<0.05).In the fourth and the twelfth weeks,JRS scores of the BTX group and the BTX+rTMS group are lower than that of the rTMS group,the difference was statistically significant(P<0.05).At the time of fourth and twelfth weeks,the BSDI of the three groups was significantly lower compared with that before treatment,the difference was statistically significant(P<0.05).At the 12th week,the BSDI score of the BTX group and the BTX+rTMS group are much lower than the rTMS group,the difference was statistically significant(P<0.05).At the time of twelfth week,there were 7 patients(23.3%)in the BTX group with a modified TWSTRS efficacy score≥3,14 patients(46.67%)in the BTX+rTMS group,and none in the rTMS group.Conclusion Low-frequency rTMS used for the treatment of BS takes a rapid onset,and has few adverse effects,but has short maintenance time of efficacy.Combined with the BTX injection,it can significantly shorten the onset time of BS patients,and can further improve the clinical efficacy.