重复经颅磁刺激治疗原发性三叉神经痛新方案的疗效观察

Observation of the Efficacy of a New Protocol for Repetitive Transcranial Magnetic Stimulation in the Treatment of Primary Trigeminal Neuralgia

目的:本研究旨在探索一种新的重复经颅磁刺激(repetitive transcranial magnetic stimulation,r TMS)治疗方案对原发性三叉神经痛(primary trigeminal neuralgia,PTN)的疗效。方法:PTN患者64例随机分为对照组和治疗组,各32例。对照组给予常规卡马西平治疗,治疗组在卡马西平治疗的基础上,再给予渐进递减式rTMS治疗(第1~2周,5次/周;第3~4周,2次/周;第5~8周,1次/周);均治疗8周。设定患者入组时间点为T_(0),每周治疗结束时分别记录为T_(1)~T_(8)。于T_(0)~T_(8)分别采用视觉模拟评分(visual analogue scale,VAS)和简明疼痛评估量表(brief pain inventory,BPI)评估各时间点的疼痛相关指标;在T_(0)、T_(4)、T_(8)时间点采用匹兹堡睡眠指数量表(Pittsburgh sleep quality index,PSQI)评估睡眠质量,采用BPI疼痛对日常生活的影响项目评估生活质量。结果:2组各脱失2例患者,最终各纳入研究30例。在T_(0)和T_(1)时间点,2组间的VAS和BPI疼痛程度项目评分差异无统计学意义(P>0.05)。T_(2)~T_(8)各时间点,治疗组的VAS、BPI疼痛程度项目评分下降幅度明显大于对照组,差异有统计学意义(P<0.05)。在治疗前,2组疼痛对日常生活影响项目评分、PSQI评分差异无统计学意义(P>0.05)。T_(4)、T_(8)时间点,治疗组的疼痛对日常生活影响项目及PSQI评分下降幅度均明显大于对照组,差异有统计学意义(P<0.05)。结论:本研究采用的rTMS治疗方案可以有效缓解PTN患者疼痛,并降低疼痛对日常生活功能的影响,改善睡眠质量。

Objective:This study aims to explore the efficacy of a new repetitive transcranial magnetic stimulation (rTMS) treatment protocol for primary trigeminal neuralgia (PTN).Methods:Sixty-four patients with PTN were randomly divided into a control group and a treatment group,each consisting of 32 patients.The control group received standard carbamazepine treatment,while the treatment group was given a progressive decremental rTMS therapy (5 sessions per week for weeks 1-2;2 sessions per week for weeks 3-4;1 session per week for weeks 5-8) in addition to carbamazepine treatment.Both groups underwent an 8-week treatmen period.The enrollment time point was designated as T_0,and at the end of each week (T_1-T_8),assessments were recorded.Visual Analogue Scale (VAS) and Brief Pain Inventory (BPI) were used to evaluate pain-related indicators at T_0-T_8.Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality at T_0,T_4,and T_8,and the BPI item assessing the impact of pain on daily life was used to evaluate quality of life.Results:Two patients dropped out from each group,resulting in a final inclusion of 30 patients per group.There were no statistically significant differences in VAS and BPI pain severity scores between the two groups at T_(0and) T_1(P>0.05).From T_(2to) T_8,the VAS and BPI pain severity scores decreased significantly more in the treatment group compared to the control group (P<0.05).Before treatment,there were no statistically significant differences in the scores of the impact of pain on daily life and PSQI between the two groups (P>0.05).At T_(4and) T_8,the treatment group showed a significantly greater reduction in the impact of pain on daily life and PSQI scores compared to the control group (P<0.05).Conclusion:The rTMS treatment protocol adopted in this study can effectively alleviate pain in PTN patients,reduce the impact of pain on daily living functions,and improve sleep quality.