del Olmo Miguel Fernández, Bello Olalla, Cudeiro Javier
Neuroscience and Motor Control Group (NEUROcom), University of A Coruña, A Coruña, Spain.
Clin Neurophysiol. 2007 Jan;118(1):131-9. doi: 10.1016/j.clinph.2006.09.002. Epub 2006 Nov 9.
Several studies have shown that repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) is effective in the treatment of depression in patients with Parkinson disease (PD). However, since research into the effect of this type of rTMS regime on motor function is limited, we studied the effect of rTMS over the DLPFC on the motor functions in PD patients.
Thirteen patients were randomly assigned into 2 groups, one receiving real-rTMS (90% of resting motor threshold, 10 Hz, 450 pulses-day for 10 consecutive days) over the DLPFC contralateral to the more affected side, and the other group receiving sham-rTMS. Assessment included a clinical motor evaluation using part III of the Unified Parkinson's Disease Rating Scale (UPDRS), and several motor tasks. The UPDRS was applied before and after 10 days of rTMS. Finger tapping, reach movement, grip movement and gait were measured in each session before and after the rTMS over the 10 day period.
Statistical analysis (ANOVA for repeated measures; group *day *side *rTMS) only showed a significant effect for finger tapping, reach movement and gait for the factor day. No significant change was reported for the UPDRS in any group.
Application of rTMS over the DLPFC as a 10 day course had no significant effect on motor functions and clinical motor status, and the improvement in performance of motor tasks can be attributed to the effects of practice.
rTMS over the DLPFC did not lead to any motor improvement in PD patients.
多项研究表明，对背外侧前额叶皮质（DLPFC）进行重复经颅磁刺激（rTMS）对帕金森病（PD）患者的抑郁症治疗有效。然而，由于此类rTMS方案对运动功能影响的研究有限，我们研究了对DLPFC进行rTMS对PD患者运动功能的影响。
13名患者被随机分为两组，一组在患侧对侧的DLPFC接受真rTMS（静息运动阈值的90%，10赫兹，连续10天每天450次脉冲），另一组接受假rTMS。评估包括使用统一帕金森病评定量表（UPDRS）第三部分进行临床运动评估以及多项运动任务。在rTMS治疗10天前后应用UPDRS。在10天期间，每次rTMS前后分别测量手指敲击、伸手动作、抓握动作和步态。
统计分析（重复测量方差分析；组天侧*rTMS）仅显示，对于手指敲击、伸手动作和步态，“天”这个因素有显著影响。任何一组的UPDRS均未报告有显著变化。
将rTMS应用于DLPFC，疗程为10天，对运动功能和临床运动状态无显著影响，运动任务表现的改善可归因于练习的效果。
对DLPFC进行rTMS并未使PD患者的运动功能得到任何改善。
