Effect of Acupuncture Cooperated with Low-frequency Repetitive Transcranial Magnetic Stimulation on Chronic Insomnia： A Randomized Clinical Trial

The effect of acupuncture cooperated with low-frequency repetitive transcranial magnetic stimulation （rTMS） on chronic insomnia was explored. Seventy-eight patients with chronic insomnia were randomly allocated into two groups： treatment group and control group. In the treatment group, the patients received acupuncture combined with rTMS treatment, and those in the control group were given acupuncture cooperated with sham rTMS treatment, 3 days per week for 4 weeks. Before and after treatment, the primary outcomes including the scores on Insomnia Severity Index （ISI） and Pittsburgh Sleep Quality Index （PSQI） and the secondary outcomes including total sleep time （TST）, sleep onset latency （SOL）, wake after sleep onset （WASO）, sleep efficiency （SE%） recorded by sleeping diary and actigraphy were observed in both groups. Seventy-five participants finished the study （38 in treatment group and 37 in control group respectively）. After treatment, the scores in the two groups were improved significantly, more significantly in the treatment group than in the control group. It can be inferred that acupuncture cooperated with rTMS can effectively improve sleep quality, enhance the quality of life of patients and has less side effects.

Effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and quality of life

Objective:To investigate the clinical effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and its impact on quality of life.Methods:60 elderly patients with dysphagia caused by acute cerebral infarction were randomly divided into rTMS group and control group,30 cases in each group.Both groups received routine drug therapy and swallowing function training.rTMS group was additionally treated by ultra-low frequency(10mHZ)repetitive transcranial magnetic stimulation for 14 days.The changes of NIHSS score andADL score and NSE serum level and Wa Tian drinking water experiment and Fujishima Ichiro dysphagia scale score and SWAL-QOL score and SF-36 score were observed between the two groups before and after treatment.The clinical effect was evaluated by Wa Tian drinking water experiment.Results:After treatment,The clinical effective rate in rTMS group was significantly higher compared with that in the control group(P<0.05),NIHSS score and serum NSE level were significantly lower compared with the control group(P<0.05),ADL score and Fujishima Ichiro dysphagia score and SWAL-QOL score and SF-36 scores were significantly higher compared with the control group(P<0.05).After treatment,SF-36 total score(or SWAL-QOL Score)was negatively correlated with NSE serum level and NIHSS score,which was positively correlated with ADL score and Fujishima Ichiro dysphagia scale score score.Conclusion:Ultra-low frequency rTMS therapy can reduce NSE level,effectively improve dysphagia in elderly patients with acute cerebral infarction and significantly improve the elderly patients'life quality.

Effect of Repetitive Transcranial Magnetic Stimulation(rTMS)Combined with Repetitive Magnetic Stimulation at Taichong Acupoint(LR3)on Depression:A Protocol for a Randomized Controlled Study

[Objectives]To explore the clinical treatment effect of repetitive transcranial magnetic stimulation(rTMS)combined with repetitive magnetic stimulation at Taichong acupoint(LR3)therapy in the treatment of depression.[Methods]60 patients who met the inclusion standard were chosen as the research subjects.They were split into two sets using a randomized parallel control method,with 30 cases each in the experimental and control groups.The experimental group adopted the treatment with rTMS+repetitive magnetic stimulation at Taichong acupoint(LR3),and the control group adopted the treatment with rTMS alone.The course of treatment was 8 weeks.Then the clinical efficacy,Hamilton Depression Scale 17 item score(HAMD-17),Symptom Check List-90(SCL-90),Patient Health Questionnaire-15(PHQ-15)and Pittsburgh Sleep Quality Index(PSQI)were compared.[Results]After treatment,the scores of HAMD-17,SCL-90,PHQ-15 and PSQI in the two groups were lower than those before and 4 weeks after treatment(P<0.05 or P<0.01),and the scores in the experimental group were inferior to those in the control group(P<0.01),The effective rate was 96.66%in the experimental group and 76.47%in the control group(P<0.05).In the course of treatment,no serious adverse reactions happened in either group.[Conclusions]The rTMS combined with repetitive magnetic stimulation at Taichong acupoint(LR3)can enhance the control of depression in the right frontal lobe,significantly improve the symptoms of depression and somatic discomfort,and improve the sleep quality of patients.It has a wide range of application,and is safe and noninvasive,so it is worthy of clinical promotion.

High frequency heart rate variability evoked by repetitive transcranial magnetic stimulation over the medial prefrontal cortex: A preliminary investigation on brain processing of acute stressor-evoked cardiovascular reactivity

Introduction: Transcranial Magnetic Stimulation (TMS) is a non-invasive technique for brain stimulation. Repetitive TMS (rTMS) over the medial Prefrontal Cortex (mPFC), Broadman Area 10 (BA10) may stimulate transynaptically perigenual Anterior Cingulate Cortex (pACC, BA 33), insula, amigdala, hypothalamus and connected branches of the Autonomic Nervous System (ANS) involved in stressorevoked cardiovascular reactivity. Stressors are associated with an increase in sympathetic cardiac control, a decrease in parasympathetic control, or both, and, consequently, an increase in systolic/stroke volume, total vascular impedance/resistance and heart rate, a decrease of baroreflex sensitivity, i.e., an increase in blood pressure/arterial tension. Objectives and Aims: The present work aims, using TMS and accordingly to Gianaros modeling, based on functional neuroimaging studies and previous neuroanatomical data from animal models, to probe the connectivity of brain systems involved in stressor-evoked cardiovascular reactivity and to explore TMS potential as a tool for detection and stratification of individual differences concerning this reactivity and hemorreological risk factors correlated with the development of Coronary Heart Disease (CHD). Methods: Both subjects, a 52 years old male and a 40 years old female with previous increased Low Frequency (LF)/High Frequency (HF) Heart Rate Variability (HRV) ratios (respectively, 4.209/3.028) without decompensated cardiorespiratory symptoms, gave informed consent, and ethico-legal issues have been observed. Electroencephalographic (EEG) monitoring has been performed for safety purposes. Immediately after administration, over the mPFC, of 15 pulses of rTMS, during 60 second, with an inductive electrical current, at the stimulating coil, of 85.9 Ampère per μsecond and 66 Ampère per μsecond, respectively, for male and female subjects (a “figure-of-eight” coil and magnetic stimulator MagLite, Dantec/Medtronic, have been used), HRV spectrum analysis (cStress software) has been performed (during 5 minutes, in supine position). Results: In both subjects, LF power, HF power and LF/HF ratio results, before and after rTMS administration, pointed towards sympathetic attenuation and parasympathetic augmentation (respectively, in male/female subject: decreased LF power—65.1 nu/69.3 nu, before rTMS;56.1 nu/41.6 nu, after rTMS;increased HF power—15.5 nu/22.9 nu, before rTMS;30.9 nu/45.5 nu, after rTMS). Conclusions: In this preliminary investigation, the existence of a link between “mind” and heart’s function has been put in evidence, through a reversible “virtual” lesion, of brain systems involved in cardiovascular control, caused by TMS. Repetitive TMS over mPFC decreased brain function involved in stressorevoked cardiovascular reactivity, suggesting the importance of TMS in the management of stress-related cardiovascular disorders.

Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction

Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex （M1）. The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.

HF-rTMS联合盐酸美金刚与尼莫地平治疗血管性痴呆的疗效及对内皮细胞功能的影响

目的探究高频重复经颅磁刺激(HF-rTMS)结合盐酸美金刚、尼莫地平治疗血管性痴呆的疗效及对内皮细胞功能的影响。方法将山东第一医科大学附属人民医院神经内科2022-02—2023-02收治的68例血管性痴呆患者纳入研究,随机分为对照组与研究组,对照组采用盐酸美金刚与尼莫地平治疗,研究组在对照组的基础上增加HF-rTMS治疗,对比2组临床疗效(包括治疗前后认知功能、日常生活能力)及对内皮细胞功能[内皮素(ET1)、可溶性细胞间黏附分子1(sICAM-1)]的影响。结果治疗前,2组简易精神状态量表(MMSE)评分、日常生活能力(ADL)评分差异无统计学意义(t=0.646、0.080,P=0.521、0.936),治疗后2组评分均有所提高,研究组MMSE、ADL评分均高于对照组(t=4.755,P<0.001;t=6.224,P<0.001)。治疗前,2组ET1、sICAM-1水平差异无统计学意义(t=0.233、0.344,P=0.817、0.732),治疗后2组水平均有所降低,研究组ET1、sICAM-1水平均低于对照组(t=4.781,P<0.001;t=2.400,P=0.019)。研究组2例(5.89%)患者在HF-rTMS治疗后出现头晕症状,后调整刺激强度症状消失。结论血管性痴呆患者经HF-rTMS联合盐酸美金刚与尼莫地平治疗后,认知功能、日常生活能力及内皮细胞功能均得以改善,联合治疗的安全性较高。

基于静息态比率低频振幅探讨头针联合rTMS对脑卒中患者认知功能的影响及神经影像学机制探讨

目的观察头针联合rTMS对脑卒中后认知障碍(PSCI)患者整体认知功能影响,同时运用静息态比率低频振幅(fALFF)探讨头针联合rTMS改善PSCI患者认知功能潜在的静息态神经影像学机制。方法将PSCI患者随机分为头针组、头针联合rTMS组(联合组),两组患者均给予常规药物治疗及康复训练,头针组选取患侧大脑顶颞前斜线干预,联合组在头针治疗的基础上,选择低频rTMS刺激健侧大脑初级运动皮层(M1),两组均连续干预两周,每天1次,每周6次,每次20 min,总共12次。比较两组患者干预前后蒙特利尔认知评估量表(MoCA)总分及分测验的差值,同时运用双重差分模型(DID)对结局指标进行趋势分析。采用fALFF检测患者局部脑区神经自发活动变化,将有统计学差异的fALFF差值与结局指标差值做偏相关分析。结果研究共纳入47例受试者,其中头针组25例、联合组22例。相对于头针组,联合组干预前后MoCA总分差值组间两两比较未见显著性差异(P=0.914>0.05),但联合组在MoCA延迟记忆分维度的评分显著提高,差异具有统计学意义(P=0.035<0.05),同时趋势分析结果亦显示联合组对于延迟记忆的改善趋势明显优于头针组,差异具有统计学意义(DID=0.80,t=2.20,P=0.033<0.05)。干预2周后,联合组患者左侧楔前叶、右侧小脑、左侧梭状回、左侧顶上回相对于基线期fALFF值的增加幅度明显弱于头针组(GRF校正,voxel P<0.01,cluster P<0.05)。偏相关分析结果显示联合组患者干预前后左侧梭状回fALFF差值与MoCA延迟记忆分测验差值呈正相关关系(r=0.719,P<0.05),其余相关分析均无统计学差异(P>0.05)。结论头针联合rTMS干预对PSCI患者延迟记忆具有一定的疗效,其潜在的神经机制可能与左侧梭状回等参与认知加工的局部脑区神经元自发活动有关。

艾司西酞普兰联合rTMS对抑郁症患者P300、MMN的影响

目的探究抑郁症患者艾司西酞普兰联合重复经颅磁刺激(rTMS)对相关电位P300与相关电位成分失匹配负波(MMN)的影响。方法应用随机数字表法将2022年2月至2023年12月于我院就诊的108例抑郁症患者分为两组,观察组(54例)及对照组(54例)。对照组应用艾司西酞普兰治疗,在其基础上观察组联合rTMS治疗。比较两组相关电位P300及MMN潜伏期、波幅、抑郁状态(HAMD-17)及认知功能(MoCA)评分;分析治疗前后P300及MMN潜伏期、波幅与HAMD-17的相关性。结果观察组治疗后的相关电位P300及MMN潜伏期均较对照组短,而波幅均较对照组高(P<0.05)。观察组治疗后的HAMD-17评分较对照组低,而MoCA评分较对照组高(P<0.05)。治疗前P300和MMN潜伏期、波幅与HAMD-17评分无相关性;治疗后,潜伏期P300及MMN与HAMD-17评分呈正相关(r=0.527、0.631),波幅P300及MMN与HAMD-17评分呈负相关(r=-0.624、-0.428)。结论抑郁症患者应用艾司西酞普兰联合rTMS治疗效果显著,有助于提升患者的认知功能,改善MMN及事项相关电位P300水平,同时还可有效缓解患者抑郁等不良情绪,对促进患者预后改善意义重大,值得临床应用。

基于神经、认知及肢体功能的高频rTMS联合量化康复训练治疗脑梗死后姿势控制障碍患者效果

目的 探究高频重复经颅磁刺激(rTMS)联合量化康复训练在脑梗死后姿势控制障碍患者中的应用价值。方法 选取2020年1月—2023年1月接受治疗的脑梗死后姿势控制障碍120例,采用随机数字表法随机将其分为3组各40例,观察组采用高频rTMS联合量化康复训练,对照1组给予高频rTMS治疗,对照2组采取量化康复训练。观察3组干预后临床效果,干预前后神经及认知功能[美国国立卫生研究院卒中量表(NIHSS)、简易智能状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)评分]、上下肢运动功能及平衡功能[上下肢Fugl-Meyer功能评分量表(FMA)、卒中患者姿势控制量表(PASS)、Brunel平衡量表(BBS)评分]、步态运动参数、表面肌电图均方根值(RMS)、脑卒中专门生活质量评估量表(SS-QOL)评分。结果 干预后,观察组总有效率(92.50%,37/40)高于对照1组(72.50%,29/40)和对照2组(70.00%,28/40)(P<0.05)。干预后,观察组NIHSS评分<对照1组<对照2组,MMSE、MoCA评分>对照1组>对照2组;观察组上下肢FMA、PASS、BBS评分及步频、步速、跨步长比率均较对照1组和对照2组高;观察组肱二头肌屈肘和肱三头肌屈伸肘表面肌电图RMS高于对照1组和对照2组;观察组SS-QOL各项评分均较对照1组和对照2组高(P<0.05)。结论 rTMS联合量化康复训练可提高脑梗死后姿势控制障碍患者临床疗效,改善肢体功能与躯体平衡能力,促进神经功能与认知恢复,且可改善肌张力与步态参数,提升生活质量。

高频rTMS联合任务导向性训练在脑卒中后偏瘫患者中的效果

目的分析高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合任务导向性训练在脑卒中后偏瘫患者中的效果。方法选取佛山市第五人民医院2020年7月—2022年1月的52例脑卒中后偏瘫患者为研究对象,根据随机数字表法分为2组,各26例。导向训练组采用务导向性训练,联合组在导向训练组基础上联合高频rTMS治疗。比较2组患者治疗前后上肢运动功能、偏瘫侧肌力以及神经功能情况。结果治疗前,2组患者上肢Fugl-Meyer评估法(Fugl-Meyer assessment,FMA)评分比较,差异无统计意义(P>0.05)。治疗后1、2、4、8、12个月,联合组的FMA评分分别为(43.86±7.13)分、(48.45±8.38)分、(52.45±7.89)分、(54.48±9.22)分、(58.42±10.43)分,高于导向训练组的(38.13±6.87)分、(41.38±7.94)分、(43.25±8.63)分、(46.12±8.21)分、(50.25±9.12)分,组间差异有统计学意义(P<0.05)。治疗前,2组患者医学研究委员会量表(Medical Research Council,MRC)评分比较,差异无统计学意义(P>0.05);治疗后1、2、4、8、12个月,联合组的MRC评分分别为(2.39±0.40)分、(2.76±0.51)分、(3.06±0.52)分、(3.47±0.47)分、(3.94±0.79)分,均高于导向训练组的(2.08±0.34)分、(2.39±0.46)分、(2.67±0.53)分、(3.10±0.49)分、(3.40±0.85)分,组间差异有统计学意义(P<0.05)。治疗前,2组患者美国国立卫生研究院卒中量表(National Institutes of Health stroke scale,NIHSS)评分比较,差异无统计意义(P>0.05);治疗后1、2、4、8、12个月,联合组的NIHSS评分分别为(21.06±3.73)分、(19.08±2.41)分、(16.47±2.03)分、(14.24±2.46)分、(13.10±2.34)分,低于导向训练组的(23.45±3.15)分、(21.09±3.56)分、(18.34±2.12)分、(16.84±2.65)分、(15.36±2.05)分,组间差异有统计学意义(P<0.05)。结论高频rTMS联合任务导向性训练应用于脑卒中后偏瘫患者中能有效改善患者偏瘫侧上肢肌力及功能,促进患者神经功能恢复,可为后期高频rTMS联合任务导向性训练在脑卒中后偏瘫患者中的应用提供理论基础。

rTMS联合早期吞咽功能分级康复训练对老年脑卒中合并吞咽障碍患者吞咽功能的影响

目的研究老年脑卒中合并吞咽障碍患者经高频重复经颅磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS)联合早期吞咽功能分级康复训练对神经及吞咽功能的临床应用价值。方法便利选取2021年1月-2023年1月泰州市第三人民医院收治的70例老年脑卒中合并吞咽障碍患者为研究对象,按随机数表法分为对照组(n=35,常规治疗)和观察组(n=35,rTMS联合早期吞咽功能分级康复训练)。比较两组治疗前后舌体移动度(舌骨上移距离、舌骨前移距离),神经功能[美国国立卫生院卒中量表(National Institutes of Health Stroke Scale,NIHSS)]、吞咽功能[标准吞咽功能评分量表(Standard Swallowing Function Assessment Scale,SSA)]及生存质量[吞咽生存质量问卷(Swallowing Quality of Life,SWAL-QOL)]评分,观察两组不良反应发生情况。结果较治疗前,两组治疗后舌骨上移距离、舌骨前移距离及SWAL-QOL评分均升高,NIHSS评分、SSA评分均降低,且观察组较对照组更优,差异有统计学意义(P均<0.05)。观察组治疗总有效率(97.14%)高于对照组(82.86%),差异有统计学意义(χ^(2)=3.968,P<0.05)。两组不良反应总发生率对比,差异无统计学意义(P>0.05)。结论在rTMS治疗基础上,老年脑卒中合并吞咽障碍患者联合早期吞咽功能分级康复训练,对自身神经功能及吞咽功能均有显著改善作用,且安全性高。

重复经颅磁刺激(rTMS)提高睡眠质量的研究

目的:探讨重复经颅磁刺激(rTMS)改善睡眠的效果,为使用rTMS提高运动员的睡眠质量提供理论基础。方法:采用被试内设计,在被试脑干的中缝核区域分别施加假刺激(S)、无刺激(N)和磁刺激(T),比较刺激后主观感觉、生理及行为的变化。结果:在被试脑干的中缝核区域施加1 Hz,80%RMT,1 500次rTMS(持续10 s间隔2 s)后,被试的自评睡眠质量提高,状态焦虑降低;呼吸曲线的波动减少、呼吸频率降低,脉率降低,心率变异性(HRV)的相邻NN间期差值的均方根(RMSSD)和相邻NN间期差值的标准差(SDSD)降低;肢体活动减少。结论:rTMS能够提高睡眠质量,rTMS刺激后呼吸、脉率以及心率变异性(HRV)的变化在一定程度上可以对其生理效果进行解释。

低频rTMS对创伤性颅脑损伤患者颅内压影响的实验研究

目的探讨低频重复经颅磁刺激(rTMS)对创伤性颅脑损伤(TBI)患者颅内压(ICP)的影响。方法32例急性中重型TBI患者分为非手术组及手术组,再分别将其随机分为常规治疗组(A组)及低频rTMS治疗组(B组)。采用无创颅内压检测分析仪测定患者的IcP。结果非手术组中B组患者的IcP均低于A组(P<0.05);手术组中,B组患者的IcP在第1天与A组相比差异无统计学意义(p>0.05),但有下降趋势,在第3天、第7天、第9天均低于A组(P<0.05)。结论低频rTMS可以降低TBI后患者的ICP,从而起到脑保护作用。

重复经颅磁刺激(rTMS)治疗对抑郁症患者时间知觉的影响

目的分析左背外侧前额叶高频重复经颅磁刺激(rTMS)治疗对抑郁症患者时间知觉的影响。方法将我院收治的64例抑郁症患者纳入本次实验,所有病例均选自2016年1月—2017年7月,采取随机抽签的方式,将其分为甲组与乙组,每组各32例。两组患者均给予药物治疗,在此基础上,甲组给予左背外侧前额叶rTMS治疗,乙组给予假rTMS治疗,对比两组患者的时间知觉和抑郁情绪改善情况。结果甲组患者600 ms时距复制误差和3 s时距复制误差均低于乙组,甲组患者HAMD评分低于乙组,两组对比,差异具有统计学意义(P<0.05)。结论对抑郁症患者采取左背外侧前额叶高频重复经颅磁刺激治疗可明显改善其时间知觉和抑郁情绪。

rTMS联合常规药物治疗精神分裂症伴强迫症的临床观察

目的:探讨rTMS联合常规药物治疗精神分裂症伴强迫症的影响。方法:选取我院2013年3月-2016年3月72例精神分裂症伴强迫症患者为研究对象,将纳入患者随机抽签分为观察组与对照组,每组36例。对照组在抗精神病治疗基础上加用氟西汀,观察组在对照组基础上给予高频率重复经颅磁刺激,比较血清素、磁共振氢质子波谱、事件相关电位P300、精神症状、强迫症状、不良反应。结果:观察组治疗4周后额叶氮-乙酰天门冬氨酸(NAA)/肌酸(Cr)、N1波幅、P3波幅显著高于对照组(t=2.436,3.201,4.774;P<0.05)。观察组治疗4周后精神症状总分(PANSS)、强迫症状总分(DY-BOCS)显著低于对照组的(t=7.236,3.721;P<0.01)。结论:高频率重复经颅磁刺激可以提高大脑皮质兴奋性,联合氟西汀可以有效改善精神分裂症状与强迫症状。

儿童自闭症感觉统合障碍干预的新视角:rTMS技术及其理论基础

感觉统合障碍是儿童自闭症的典型共症之一,对患儿的正常生活影响巨大。传统干预手段从应用行为分析出发,侧重游戏矫正,但干预费时费力且效果十分有限。随着神经科学技术手段的应用发展,根据患儿Gamma频段脑电活动异常机制而进行的重复经颅磁刺激(r TMS)干预,已成为自闭症感觉统合障碍干预治疗的新方向。本文对技术的理论基础及其应用发展过程进行了回顾。

低频rTMS对TBI患者兴奋性毒性指数的影响

目的探讨低频重复经颅磁刺激(rTMS)对颅脑损伤(TBI)患者兴奋性毒性指数(EI)的影响。方法 48例急性TBI患者按GCS评分分为轻型组(MI组)、中型组(MO组)及重型组(SE组),根据治疗方法每组又分为两亚组,即常规治疗组(c组)及低频rTMS治疗组(r组),每亚组8例患者。治疗7 d后,采用高效液相色谱法测定患者脑脊液中谷氨酸(Glu)、甘氨酸(Gly)、γ-氨基丁酸(GABA)的浓度并计算出兴奋性毒性指数(EI)=[Glu]×[Gly]/[GABA]。结果对于轻型颅脑损伤患者,与c组相比,r组脑脊液Glu、Gly、GABA浓度及EI均有下降趋势,但无统计学差异(P>0.05)。对于中型颅脑损伤患者,与c组相比,r组脑脊液Glu、GABA及EI均明显降低(P<0.05)。对于重型颅脑损伤患者,与c组相比,r组脑脊液Glu、Gly、GABA及EI均明显降低(P<0.05)。结论低频rTMS可以减轻中、重型TBI患者的兴奋毒性,从而起到脑保护作用。

rTMS治疗中重度抑郁症患者睡眠障碍的临床研究

目的探讨低频重复经颅磁刺激(rTMS)治疗中重度抑郁症患者睡眠障碍的临床效果。方法选取我院确诊的120例中重度抑郁症(HAMD评分≥17分)伴睡眠障碍患者,收治时间2014年1月~2016年1月,采用随机数字表法分为对照组和研究组各60例,两组患者均给予基础的抗抑郁治疗措施,研究组同时给予rTMS方法治疗,疗程为1个月。结果治疗前,研究组和对照组的PSQI评分、HAMD评分比较差异无统计学意义(P>0. 05);治疗后,两组患者的PSQI评分、HAMD评分较治疗前均降低,差异有统计学意义(P<0. 05),研究组患者的PSQI评分、HAMD评分低于对照组,差异有统计学意义(P<0. 05);治疗前,研究组和对照组的睡眠总时间、睡眠潜伏期、REM睡眠潜伏期、NREM%、REM%值比较差异无统计学意义(P>0. 05);治疗后,两组患者的睡眠潜伏期、NREM%值较治疗前均显著的降低(P<0. 05),睡眠总时间、REM睡眠潜伏期、REM%值较治疗前显著的提高,差异有统计学意义(P <0. 05);治疗后,研究组患者的睡眠潜伏期、NREM%值显著的低于对照组,差异有统计学意义(P<0. 05),研组患者的睡眠总时间、REM睡眠潜伏期、REM%值显著的高于对照组(P<0. 05)。结论 rTMS治疗中重度抑郁症患者睡眠障碍效果显著,能显著的延长总睡眠时间、REM睡眠潜伏期。

低频rTMS对脑梗死后肢体运动功能障碍的康复作用

目的:观察低频重复经颅磁刺激(r TMS)对脑梗死患者肢体运动功能障碍的康复作用。方法:选取154例急性脑梗死伴肢体运动功能障碍患者,按照数字列表法将患者随机分为对照组和观察组,每组77例。两组均进行脑梗死常规药物治疗;观察组在常规药物治疗基础上加以1 Hz的低频r TMS治疗,30 min/d,10 d为一个疗程;对照组则给予假刺激治疗;两组患者治疗后均进行运动康复训练。比较两组治疗前后神经功能缺损评分(NIHSS)、Barthel指数(BI)及Fugl-Meyer评估(FMA),同时对两组患者病变侧脑区运动诱发电位(MEP)潜伏期及波幅进行测定。结果:(1)两组治疗前NIHSS评分、BI及FMA评分差异无统计学意义(t=0.153,t=0.235,t=0.126;P>0.05);治疗10 d后观察组的NIHSS评分、BI及FMA评分均优于对照组,两组比较差异有统计学意义(t=3.264,t=9.461,t=4.302;P<0.05);(2)两组治疗前MEP潜伏期及MEP波幅差异无统计学意义(t=0.027,t=0.032,P>0.05)。治疗10 d后观察组MEP潜伏期明显短于对照组,MEP波幅明显高于对照组,两组比较差异有统计学意义(t=3.764,t=6.020;P<0.05)。结论:r TMS治疗对脑梗死患者肢体运动功能障碍有一定康复作用,但其远期疗效还有待于进一步的临床观察。

中药药枕联合rTMS治疗脑卒中失眠的效果观察

目的探讨中药药枕联合重复低频经颅磁刺激(rTMS)治疗脑卒中后失眠的效果。方法80例脑卒中后失眠患者分为对照组和观察组,各40例。对照组采用艾司唑仑药物治疗联合常规护理,观察组在对照组基础上增加中药药枕联合rTMS治疗。连续治疗4周,随访3个月。运用匹兹堡睡眠质量指数(PSQI)量表和SPIEGEL量表评价患者睡眠质量,对比2组临床疗效。结果治疗4周后,2组PSQI、SPIEGEL评分较治疗前下降,且观察组PSQI、SPIEGEL评分改善优于对照组(P<0.01)。观察组临床疗效优于对照组(92.50%vs.72.50%,P<0.05)。结论应用中药药枕联合rTMS能进一步缓解卒中后失眠症状,效果更为稳定和安全。