CAJ | 학술논문

目的探讨重复性经颅磁刺激治疗儿童Tourette综合征（ TS）疗效及安全性。方法选择首都儿科研究所附属儿童医院神经内科门诊确诊的TS患儿30例，病程超过1年，正规药物治疗无效。在原药治疗基础上应用重复性经颅磁刺激（ rTMS）治疗。rTMS治疗参数：rTMS作用于辅助运动区（ Cz前方3 cm），给予频率为0.5 Hz，磁场强度为50%~70%运动阈值，每序列20次脉冲，序列间隔2 s，60个序列，共1200次脉冲，一次性连续刺激。共治疗10天。rT-MS治疗前以及治疗后即刻、第4、8周内分别进行耶鲁综合抽动严重程度量表（ YGTSS）评估。结果①治疗后即刻症状好转7例，显效、痊愈各3例；治疗后4周好转7例，显效7例，痊愈3例；治疗后8周好转7例，显效10例，痊愈3例，总有效率66.67%。②rTMS对发声抽动治疗的有效率显著高于运动抽动治疗的有效率（ P ﹤0.001）。③所有患儿均能耐受治疗过程，无不良反应。结论应用低频的rTMS对辅助运动区进行刺激是辅助治疗TS的有效方法，本治疗方法对发声性抽动的改善情况明显好于运动性抽动。治疗过程不良反应少。
목적탐토중복성경로자자격치료인동Tourette종합정（ TS）료효급안전성。방법선택수도인과연구소부속인동의원신경내과문진학진적TS환인30례，병정초과1년，정규약물치료무효。재원약치료기출상응용중복성경로자자격（ rTMS）치료。rTMS치료삼수：rTMS작용우보조운동구（ Cz전방3 cm），급여빈솔위0.5 Hz，자장강도위50%~70%운동역치，매서렬20차맥충，서렬간격2 s，60개서렬，공1200차맥충，일차성련속자격。공치료10천。rT-MS치료전이급치료후즉각、제4、8주내분별진행야로종합추동엄중정도량표（ YGTSS）평고。결과①치료후즉각증상호전7례，현효、전유각3례；치료후4주호전7례，현효7례，전유3례；치료후8주호전7례，현효10례，전유3례，총유효솔66.67%。②rTMS대발성추동치료적유효솔현저고우운동추동치료적유효솔（ P ﹤0.001）。③소유환인균능내수치료과정，무불량반응。결론응용저빈적rTMS대보조운동구진행자격시보조치료TS적유효방법，본치료방법대발성성추동적개선정황명현호우운동성추동。치료과정불량반응소。
Objective To explore and analyze the effect and safety of treatment in Tourette Syndrome( TS)with repetitive transcranial magnetic stimulate. Methods 30 TS cases of out - patient children were selected retrospectively into this study. All patients did not show effective treatment after one drug therapy. The study group were treated by rTMS combined with original medicine. The parameters of rTMS treatment included effect on supplementary motor area,giving a frequency of 0. 5HZ,magnetic field strength is 50% ~70% of motor threshold. There were 60 sequences,20 pulses per sequence. A total pulses were 1 200. The patients were treated with rTMS for 10 daily sessions. The patients were respectively detected by Yale Global Tourtte's Syndrome Severity Scale(YGTSS )before and after the intervention immediately,28 days and 56 days after treatment. Results ①The tics symptoms of 7 patients were improved,effectively improved in 3 patients. 3 patients were cured after immediate treatment. The tics symptoms of 7 patients were improved,effective improved in 7 patients. 3 patients were cured 28 days after treatment of rTMS. The tics symptoms of 7 patients were improved,effective improved in 10 patients. 3 patients were cured 56 days after treatment of rTMS. Total efficiency was 66. 67%. ②The vocal tic reduction rate was significantly higher than that of motor tics of the reduction rate with rTMS( P ﹤0. 01). ③All patients were tolerate to the treatment without side - effects. Conclusion Low - frequence rTMS over the SMA was an effective adjuvant therapy on TS. The improvement of vocal tics was significant than that of motor tics. Less adverse reactions were reported during treatment.