Khedr E M, Farweez H M, Islam H
Department of Neurology, Assiut University Hospital, Assiut, Egypt.
Eur J Neurol. 2003 Sep;10(5):567-72. doi: 10.1046/j.1468-1331.2003.00649.x.
Cortical excitability of the primary motor cortex is altered in patients with Parkinson's disease (PD). Therefore, modulation of cortical excitability by high frequency repetitive transcranial magnetic stimulation (rTMS) of the motor cortex might result in beneficial effects on motor functions in PD. The present study aims to evaluate the effect of rTMS of the motor cortex on motor functions in patients with PD. Thirty-six unmedicated PD patients were included consecutively in this study. The patients were assigned in a randomized pattern to one of two groups, one group receiving real-rTMS (suprathreshold 5-Hz, 2000 pulses once a day for 10 consecutive days) and the second group receiving sham-rTMS using closed envelopes. Total motor section of Unified Parkinson's Disease Rating Scale (UPDRS), walking speed, and self-assessment scale were performed for each patient before rTMS and after the first, fifth, 10th sessions, and then after 1 month. Evaluation of these measures was performed blindly without knowing the type of rTMS. anova for repeated measurements revealed a significant time effect for the total motor UPDRS, walking speed and self-assessment scale during the course of the study in the group of patients receiving real-rTMS (P = 0.0001, 0.001, and 0.002), while no significant changes were observed in the group receiving sham-rTMS except in self-assessment scale (P = 0.019). A 10-day course of real-rTMS resulted in statistically significant long-term improvement of the motor functions in comparison with the sham-rTMS. The rTMS could have a therapeutic role of for PD patients.
帕金森病（PD）患者的初级运动皮层的皮质兴奋性会发生改变。因此，通过对运动皮层进行高频重复经颅磁刺激（rTMS）来调节皮质兴奋性可能会对PD患者的运动功能产生有益影响。本研究旨在评估运动皮层rTMS对PD患者运动功能的影响。本研究连续纳入了36例未用药的PD患者。患者被随机分配到两组中的一组，一组接受真正的rTMS（阈上5赫兹，每天2000次脉冲，连续10天），另一组使用封闭信封接受假rTMS。在rTMS之前以及第一次、第五次、第十次治疗后以及1个月后，对每位患者进行统一帕金森病评定量表（UPDRS）的总运动部分、步行速度和自我评估量表的评估。在不知道rTMS类型的情况下对这些指标进行盲法评估。重复测量方差分析显示，在接受真正rTMS的患者组中，研究过程中总运动UPDRS、步行速度和自我评估量表有显著的时间效应（P = 0.0001、0.001和0.002），而在接受假rTMS的组中，除自我评估量表外未观察到显著变化（P = 0.019）。与假rTMS相比，为期10天的真正rTMS疗程导致运动功能有统计学意义的长期改善。rTMS可能对PD患者具有治疗作用。
