电刺激小脑治疗脑卒中后抑郁的临床探讨

A clinical study of fastigial nucleus electrical stimulation on poststroke depression

目的评价电刺激小脑对脑卒中后抑郁患者的治疗作用,探讨其治疗机制。方法收集本院神经内科脑卒中住院患者97例,其中合并抑郁患者41例,分综合治疗和药物治疗组;其他56非抑郁患者为对照组。采用量表评定及血浆单胺类神经递质含量测定的方法对电刺激小脑及抗抑郁药物治疗后的脑卒中后抑郁患者进行评价,并与单纯药物治疗的脑卒中后抑郁患者及脑卒中非抑郁患者进行比较。结果综合治疗组治疗后HAMD分数为10±8,药物治疗组治疗后分数为14±8,其两组分数虽在统计学上差异无显著性意义(t=1.5948,P=0.1188),但治疗后综合治疗组分数有明显下降的趋势。综合治疗组治疗后MMSE分数为23±5,药物治疗组治疗后分数为19±5,综合治疗组的MMSE分值较药物治疗组增加(t=2.1774,P=0.0356)。综合治疗组治疗后血浆单胺类递质水平较治疗前明显升高(P<0.05)。药物治疗组治疗前后的单胺类递质含量除去甲肾上腺素外差异均无显著性意义。结论电刺激小脑与抗抑郁药物合用能显著改善脑卒中后抑郁患者的抑郁症状,其机制可能与电刺激小脑促进单胺类神经递质释放及改善认识功能有关。

Aim To investigate the effect of electrical stimulation on poststroke depression.Methods Among 97inpatients with stroke from2000-01to 2002-08,41patients with post-stroke depression were divided into two group:complex therapy grou p and routine drugs group;56without depression as a control group.Scale examinations(HAMD and MMSE)and the concentrations of monoamine neu rotransmitters in plasma were exami ned in complex therapy group treated with electrical stimulation and antidepres-sant drugs compared with routine dru gs group and control group scale ex-amination and the concentrations of monoamine neurotransmitters in pla sma.Results(1)The HAMD scores of complex therapy group(10±8)were significantly lower than those of ro utine drugs group(14±8),but there were no significant differences statistically(t=1.5948,P=0.1188).(2)The MMSE scores of complex therapy group(23±5)were significantly higher than those of routine drugs group(19±5)(t=2.1774,P=0.0356).(3)The concentrations of monoamine neu rotransmitters in plasma after trea tment (1.18±0.35,0.29±0.04,2.46±0.30)were obviously higher than those before treatment (1.42±0.38,0.39±0.05,2.72±0.41)in complex therapy group.There were no significant differences between the concen tra-tions of monoamine neurotransmitte rs in plasma before and after treatme nt except the concentration of NE in rou tine drugs group.Conclusion Fastigial nucleus electrical stimulations im prove emotion disorders of post-str oke pa-tients,which is associated with increasing the concentrations of monoa mine neurotransmitters in plasma.It is s uggested that fastigial nucleus sti mulation may have potential of antidepressio n.SUBJECT WORDS:depressive disorder /therapy;electric stimulation;cere-brovascular accident /complicatio ns;cerebrovascular accident /rehabilita-tion;biogenic amine neurotransmittersABSTRACT:Aim To evaluate the usefulness of MRI for the diagnosis of Alzheimer's dementia(AD)and explore the relationships betwe en hip-pocampal MRI measurements and cogni tive impairment in AD patients.Methods The height and volume of hippocampus,width of temporal angle,and thickness of insula lobe in hippocampal area were evaluated quantita-tively by MRI linear and volume measu ring and their cognitive function wa s rated by mini-mental sate examinati on(MMSE),Wechsler memory scale(WMS ),Wechsler's adult intelligence scale(WAIS),VIQ,PIQ,FIQ,and MQ among 30AD patients,16males a nd 14females,aged 56-83,and 27normal controls,14males and 13females,aged 58-82,with a MMSE score >26.The relationships between the hippocampal MRI mea-surements and scores of cerebral function were analyzed.Results The width of temporal angle was(5.6±2.4)mm in the left side and(5.2±2.2)mm in the right,the height hippocampus was(9.4±3.5)mm and(9.4±3.6)mm in the two sides respectively,and the volume of hippocampus was(2210±420)mm 3 and(2488±360)mm 3 in the two sides respectively in the AD group,all significantly lowe r than those of the normal controls(all P<0.01).The scores of MMSE WMS,WAIS,VIQ,PI Q,FIQ,and MQ were 16.14±5.12,30.97±8.23,29.80±9.54,69.23±14.2,and 050.12±12.24respectively in the AD g roup ,all significantly lower than those in the control group(30.08±3.15.50.01±10.91,50.56±11.21,95.35±16.45,and 90.45±17.64respectively,all P<0.01).The MMSES core showed a highly positive c orrelation with the width of tempora l angle,and the height and volume of hi ppocampus,and the WMS score was positively correlated with the widt h of temporal angle(r =0.652-0.894,P<0.01).Conclusion A valuable diagnostic tool for AD,quantitative MRI linear and volume measuring for hippocampus provides objective evidences with its results in good accordance with cognitive function rating resul ts.