Hamada Masashi, Ugawa Yoshikazu, Tsuji Sadatoshi
Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Mov Disord. 2008 Aug 15;23(11):1524-31. doi: 10.1002/mds.22168.
Dysfunction of the basal ganglia-thalamocortical motor circuit is a fundamental model to account for motor symptoms in Parkinson's disease (PD). Using high-frequency repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA), we investigated whether modulation of SMA excitability engenders therapeutic effects on motor symptoms in PD. In this double-blind placebo-controlled study, 99 patients were enrolled and assigned randomly to SMA-stimulation and sham-stimulation groups. For SMA stimulation, 20 trains of 50 transcranial magnetic stimuli at 5 Hz were delivered at an intensity of 110% active motor threshold for leg muscles in one session. The sham stimulation was 20 trains of electric stimuli given through electrodes fixed on the head to mimic the cutaneous sensation during rTMS. Each session of intervention was carried out once a week for the first 8 weeks. The SMA stimulation, in contrast to the sham stimulation, engendered significant improvements in total scores and motor scores of the Unified Parkinson's Disease Rating Scale. Mean improvements in motor scores were 4.5 points in the SMA-stimulation group and -0.1 points in the sham-stimulation group. Results indicate that 5 Hz rTMS over SMA modestly improves motor symptoms in PD patients; SMA is a potential stimulation site for PD treatment.
基底神经节-丘脑皮质运动回路功能障碍是解释帕金森病（PD）运动症状的一个基本模型。我们通过对辅助运动区（SMA）进行高频重复经颅磁刺激（rTMS），研究了SMA兴奋性的调节是否对PD的运动症状产生治疗效果。在这项双盲安慰剂对照研究中，99名患者入组并随机分为SMA刺激组和假刺激组。对于SMA刺激，在一次治疗中，以腿部肌肉主动运动阈值的110%强度，给予20组、每组50次、频率为5Hz的经颅磁刺激。假刺激是通过固定在头部的电极给予20组电刺激，以模拟rTMS期间的皮肤感觉。在最初的8周内，每周进行一次干预治疗。与假刺激相比，SMA刺激使统一帕金森病评定量表的总分和运动评分有显著改善。运动评分的平均改善在SMA刺激组为4.5分，在假刺激组为-0.1分。结果表明，对SMA进行5Hz的rTMS可适度改善PD患者的运动症状；SMA是PD治疗的一个潜在刺激部位。
