Khedr Eman M, Rothwell John C, Shawky Ola A, Ahmed Mohamed A, Hamdy Ahmed
Department of Neurology, Assiut University Hospital, Assiut, Egypt.
Mov Disord. 2006 Dec;21(12):2201-5. doi: 10.1002/mds.21089.
Previous studies in patients with Parkinson's disease have reported that a single session of repetitive transcranial magnetic stimulation (rTMS) can improve some or all of the motor symptoms for 30 to 60 minutes. A recent study suggested that repeated sessions of rTMS lead to effects that can last for at least 1 month. Here we report data that both confirm and extend this work. Fifty-five unmedicated PD patients were classified into four groups: two groups (early and late PD) received 25 Hz rTMS bilaterally on the motor arm and leg areas; other groups acted as control for frequency (10 Hz) and for site of stimulation (occipital stimulation). All patients received six consecutive daily sessions (3,000 pulses for each session). The first two groups then received a further three booster sessions (3 consecutive days of rTMS) after 1, 2, and 3 months, while the third group had only one additional session after the first month. Unified Parkinson's Disease Rating Scale (UPDRS), walking time, key-tapping speed, and self-assessment scale were measured for each patient before and after each rTMS session and before and after the monthly sessions. Compared to occipital stimulation, 25 Hz rTMS over motor areas improved all measures in both early and late groups; the group that received 10 Hz rTMS improved more than the occipital group but less than the 25 Hz groups. The effect built up gradually during the sessions and was maintained for 1 month after, with a slight reduction in efficacy. Interestingly, the effect was restored and maintained for the next month by the booster sessions. We conclude that 25 Hz rTMS can lead to cumulative and long-lasting effects on motor performance.
先前针对帕金森病患者的研究报告称，单次重复经颅磁刺激（rTMS）可使部分或所有运动症状在30至60分钟内得到改善。最近一项研究表明，多次重复经颅磁刺激会产生至少持续1个月的效果。在此，我们报告的数据既证实又拓展了这项研究成果。55名未接受药物治疗的帕金森病患者被分为四组：两组（早期和晚期帕金森病患者）在运动手臂和腿部区域接受双侧25赫兹的重复经颅磁刺激；其他组分别作为频率（10赫兹）和刺激部位（枕部刺激）的对照组。所有患者连续6天每天接受一次治疗（每次治疗3000个脉冲）。然后，前两组在1个月、2个月和3个月后又接受了连续3天的强化治疗，而第三组仅在第一个月后额外接受了一次治疗。在每次重复经颅磁刺激治疗前后以及每月治疗前后，对每位患者进行统一帕金森病评定量表（UPDRS）、步行时间、按键速度和自我评估量表的测量。与枕部刺激相比，运动区域的25赫兹重复经颅磁刺激改善了早期和晚期两组的所有测量指标；接受10赫兹重复经颅磁刺激的组比枕部刺激组改善更多，但比25赫兹刺激组少。这种效果在治疗过程中逐渐增强，并在治疗后维持1个月，疗效略有下降。有趣的是，强化治疗在下个月恢复并维持了这种效果。我们得出结论，25赫兹重复经颅磁刺激可对运动表现产生累积和持久的影响。
