重复经颅磁刺激对帕金森病非运动症状康复疗效的研究
중복경로자자격대파금삼병비운동증상강복료효적연구
Rehabilitating the non-motor symptoms of Parkinson's disease using repetitive transcranial magnetic stimulation
  • 万方数据
    中华物理医学与康复杂志 중화물리의학여강복잡지
    CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
    2012年 12期 911-915 ,共5页

    苏敏%韩立影%刘传道%昝云强%杨卫新

    소민%한립영%류전도%잠운강%양위신

    经颅磁刺激%帕金森病%非运动症状%康复疗效 經顱磁刺激%帕金森病%非運動癥狀%康複療效
    경로자자격%파금삼병%비운동증상%강복료효
    Transcranial magnetic stimulation%Parkinson's disease%Non-motor symptoms%Rehabilitation
    目的 探讨重复经颅磁刺激(rTMS)对帕金森病(PD)患者非运动症状的康复疗效.方法 选取PD患者55例,按随机数字表法分为治疗组和假刺激组,治疗组29例,假刺激组26例.治疗组患者给予频率为0.5 Hz的经颅磁刺激治疗,假刺激组患者以同样方式置于经颅磁刺激仪器下,但仪器无能量输出.分别于治疗前、治疗后和治疗后1个月采用30项非运动症状筛查问卷(NMSQuest)、汉密尔顿抑郁量表(HAMD)、帕金森病睡眠量表(PDSS)、简易精神状态量表(MMSE)及帕金森病自主神经症状量表(SCOPA-AUT)对患者的非运动症状发生率、抑郁状况、睡眠状况、认知功能及自主神经功能障碍程度进行评定.结果 与治疗前相比,治疗组治疗后NMSQuest评分显著下降(P＜0.05),治疗后1个月,治疗组非运动症状改善效果与治疗前相比并不显著(P＞0.05),但假刺激组治疗后及治疗后1个月NMSQuest评分逐渐增高(P＜0.05),2组比较,治疗组疗效明显优于假刺激组(P＜0.05)；治疗组治疗后及治疗后1个月的HAMD评分较治疗前均降低(P＜0.05),假刺激组治疗后及治疗后1个月的HAMD评分逐渐增高(P＜0.05),治疗后及治疗后1个月治疗组患者抑郁改善程度均优于假刺激组(P＜0.05)；治疗组治疗后睡眠障碍明显缓解(P＜0.05),治疗后1个月,治疗组睡眠障碍改善效果与治疗前相比并不显著(P＞0.05),而假刺激组PDSS评分逐渐降低,虽然患者的睡眠障碍未明显加重(P＞0.05),但2组同时间点比较,治疗组睡眠障碍改善效果均优于假刺激组(P＜0.05)；治疗组治疗后认知功能水平提高(P＜0.05),但治疗后1个月时认知功能改善效果减退(P＞0.05),而假刺激组MMSE量表得分逐渐下降(P＞0.05),治疗组与假刺激组相比,组间差异有统计学意义(P＜0.05)；治疗后及治疗1个月后,治疗组及假刺激组SCOPA-AUT评分与治疗前相比均无统计学意义(P＞0.05),组间差异无统计学意义(P＞0.05).结论 rTMS治疗可明显改善PD患者的多数非运动症状,以抑郁情绪改善最为显著,但短疗程rTMS治疗不能持续改善PD患者的自主神经功能失调症状.
    목적 탐토중복경로자자격(rTMS)대파금삼병(PD)환자비운동증상적강복료효.방법 선취PD환자55례,안수궤수자표법분위치료조화가자격조,치료조29례,가자격조26례.치료조환자급여빈솔위0.5 Hz적경로자자격치료,가자격조환자이동양방식치우경로자자격의기하,단의기무능량수출.분별우치료전、치료후화치료후1개월채용30항비운동증상사사문권(NMSQuest)、한밀이돈억욱량표(HAMD)、파금삼병수면량표(PDSS)、간역정신상태량표(MMSE)급파금삼병자주신경증상량표(SCOPA-AUT)대환자적비운동증상발생솔、억욱상황、수면상황、인지공능급자주신경공능장애정도진행평정.결과 여치료전상비,치료조치료후NMSQuest평분현저하강(P＜0.05),치료후1개월,치료조비운동증상개선효과여치료전상비병불현저(P＞0.05),단가자격조치료후급치료후1개월NMSQuest평분축점증고(P＜0.05),2조비교,치료조료효명현우우가자격조(P＜0.05)；치료조치료후급치료후1개월적HAMD평분교치료전균강저(P＜0.05),가자격조치료후급치료후1개월적HAMD평분축점증고(P＜0.05),치료후급치료후1개월치료조환자억욱개선정도균우우가자격조(P＜0.05)；치료조치료후수면장애명현완해(P＜0.05),치료후1개월,치료조수면장애개선효과여치료전상비병불현저(P＞0.05),이가자격조PDSS평분축점강저,수연환자적수면장애미명현가중(P＞0.05),단2조동시간점비교,치료조수면장애개선효과균우우가자격조(P＜0.05)；치료조치료후인지공능수평제고(P＜0.05),단치료후1개월시인지공능개선효과감퇴(P＞0.05),이가자격조MMSE량표득분축점하강(P＞0.05),치료조여가자격조상비,조간차이유통계학의의(P＜0.05)；치료후급치료1개월후,치료조급가자격조SCOPA-AUT평분여치료전상비균무통계학의의(P＞0.05),조간차이무통계학의의(P＞0.05).결론 rTMS치료가명현개선PD환자적다수비운동증상,이억욱정서개선최위현저,단단료정rTMS치료불능지속개선PD환자적자주신경공능실조증상.
    Objective To research the clinical rehabilitative effect of repeated transcranial magnetic stimulation (rTMS) for the non-motor symptoms of Parkinson's disease.Methods Fifty-five PD patients were randomly divided into an rTMS treatment group (n =29) and a sham stimulation group (n =26).The treatment group received a course of 0.5 Hz rTMS treatment,while the sham stimulation group had the same treatment but with no energy output.Both groups were evaluated using a non-motor symptoms questionnaire (NMSQuest),the Hamilton depression scale (HAMD),the Pediatric Daytime Sleepiness Scale (PDSS),the mini-mental state examination (MMSE) and the scale for outcomes in PD for autonomic symptoms (SCOPA-AUT) before treatment,immediately after,and a month after treatment.Results Compared with before treatment,the average NMSQuest score of the treatment group declined significantly,though 1 month after treatment the improvement was no longer significant.After treatment and 1 month later the average NMSQuest score of the sham stimulation group increased gradually.The effect in the treatment group was therefore significantly better than in the sham stimulation group.After treatment and 1 month later the average HAMD score of the treatment group was significantly lower than before treatment while the average HAMD score of the sham stimulation group had increased gradually.The improvement in depression in the treatment group was therefore significantly better than in the sham stimulation group.After treatment,sleep disorders in the treatment group had been significantly alleviated,but one month later the improvement was no longer significant compared with before treatment.PDSS scores in the sham stimulation group declined gradually,but the improvement in sleep disorders among the treatment group was significantly better than among the sham stimulation group.Cognition improved significantly among the treatment group right after treatment,but 1 month later it had worsened while the MMSE scores of the sham stimulation group decreased gradually.The difference between the two groups was statistically significant.The average SCOPA-AUT scores of the two groups were not significantly different from each other or from the scores before treatment.Conclusion Repeated TMS can improve most non-motor symptoms of PD.The improvement in depression is the most significant.A short course of rTMS has no obvious rehabilitative effect on the autonomic function disorders of PD patients.
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