Lomarev Mikhail P, Kanchana Sulada, Bara-Jimenez William, Iyer Meena, Wassermann Eric M, Hallett Mark
Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892-1428, USA.
Mov Disord. 2006 Mar;21(3):325-31. doi: 10.1002/mds.20713.
The objective of this study is to assess the safety and efficacy of repetitive transcranial magnetic stimulation (rTMS) for gait and bradykinesia in patients with Parkinson's disease (PD). In a double-blind placebo-controlled study, we evaluated the effects of 25 Hz rTMS in 18 PD patients. Eight rTMS sessions were performed over a 4-week period. Four cortical targets (left and right motor and dorsolateral prefrontal cortex) were stimulated in each session, with 300 pulses each, 100% of motor threshold intensity. Left motor cortex (MC) excitability was assessed using motor evoked potentials (MEPs) from the abductor pollicis brevis. During the 4 weeks, times for executing walking and complex hand movements tests gradually decreased. The therapeutic rTMS effect lasted for at least 1 month after treatment ended. Right-hand bradykinesia improvement correlated with increased MEP amplitude evoked by left MC rTMS after individual sessions, but improvement overall did not correlate with MC excitability. rTMS sessions appear to have a cumulative benefit for improving gait, as well as reducing upper limb bradykinesia in PD patients. Although short-term benefit may be due to MC excitability enhancement, the mechanism of cumulative benefit must have another explanation.
本研究的目的是评估重复经颅磁刺激(rTMS)对帕金森病(PD)患者步态和运动迟缓的安全性和有效性。在一项双盲安慰剂对照研究中,我们评估了25Hz rTMS对18例PD患者的影响。在4周内进行了8次rTMS治疗。每次治疗刺激四个皮质靶点(左侧和右侧运动皮质以及背外侧前额叶皮质),每次300个脉冲,强度为运动阈值的100%。使用拇短展肌的运动诱发电位(MEP)评估左侧运动皮质(MC)的兴奋性。在这4周内,执行步行和复杂手部运动测试的时间逐渐减少。治疗性rTMS的效果在治疗结束后至少持续1个月。单次治疗后,右手运动迟缓的改善与左侧MC rTMS诱发的MEP波幅增加相关,但总体改善与MC兴奋性无关。rTMS治疗似乎对改善PD患者的步态以及减轻上肢运动迟缓具有累积益处。虽然短期益处可能归因于MC兴奋性增强,但累积益处的机制必有其他解释。