不同颅脑部位经颅直流电刺激治疗帕金森病冻结步态的疗效观察

Efficacy of tDCS in different cranial parts of the brain in the treatment of frozen gait in Parkinson’s disease

目的:观察经颅直流电刺激(tDCS)治疗帕金森病(PD)冻结步态的临床疗效。方法:选取2023年1月~2023年6月在新乡医学院第一附属医院治疗的PD患者共72例,采用随机数字表法分为对照组、初级运动皮层组(M1组)及左背外侧前额叶皮层组(L-DLPFC组),每组24例。M1组将阳极放置在优势半球M1头皮处,L-DLPFC组将阳极放置在优势半球DLPFC头皮处,阴极均放置在对侧眶上裂,M1组及L-DLPFC组刺激强度为2mA,每次持续时间20min,对照组电极放置位置与M1组相同,仅前1min内给予2mA的刺激。刺激治疗5d。于治疗前及治疗5d后分别采用帕金森病综合评定量表的第3部分(MDS-UPDRSⅢ)、帕金森病冻结步态(FOG)评分、起立行走计时测试(TUGT)对3组患者进行评估。结果:治疗后,M1组、L-DLPFC组MDS-UPDRSⅢ、FOG评分、TUGT时间均较治疗前减少(均P<0.05);M1组、L-DLPFC组MDS-UPDRSⅢ、FOG评分、TUGT时间均较对照组减少(均P<0.05);M1组与L-DLPFC组MDS-UPDRSⅢ、FOG评分、TUGT时间比较差异无统计学意义。结论:在优势半球M1及L-DLPFC应用tDCS可在短时间内改善帕金森病患者的冻结步态症状,提高生活质量。

Objective:To observe the clinical effect of transcranial direct current stimulation(tDCS)on frozen gait in Parkinson’s disease(PD).Methods:From January 2023 to June 2023,a total of 72 PD patients hospitalized in the First Affiliated Hospital of Xinxiang Medical University were selected and divided into control group,M1 group and L-DLPFC group by a random number table method,with 24 cases in each group.In the M1 placed group,the anode was on the M1 scalp of the dominant hemisphere.In the L-DLPFC group,the anode was placed on the DLPFC scalp of the dominant hemisphere.The cathodes were placed in the contralateral supraorbital fissure.The stimulation intensity of M1 group and L-DLPFC group was 2 mA for 20 min every time.The position of the electrodes in control group was the same as that in M1 group,and the stimulation was given only 2 mA for 1 min.The stimulation was given for 5 consecutive days.Three scales such as MDS-UPDRS,FOG Score and TUGT were used to evaluate the effects of treatment on day 0 and day 5.Results:MDS-UPDRSⅢ,FOG score and TUGT time after treatment in M1 group and L-DLPFC group were significantly reduced as compared with those before treatment(P<0.05).Compared with control group,MDS-UPDRSⅢ and FOG scores and TUGT time in M1 group and L-DLPFC group were significantly decreased after the treatment(P<0.05).There was no statistically significant difference in the MDS-UPDRSⅢ and FOG scores and TUGT time between the M1 group and L-DLPFC group at the same time points.Conclusion:The tDCS in dominant hemispheres(M1 and L-DLPFC)can improve the frozen gait of patients with PD in a short time and improve the quality of life.