Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neuromodulation and Neurosurgery, Office for University-Industry Collaboration, Osaka University, Osaka, Japan.
Brain Stimul. 2013 Nov;6(6):884-91. doi: 10.1016/j.brs.2013.05.002. Epub 2013 May 29.
Repetitive transcranial magnetic stimulation (rTMS) has been reported to be clinically effective for treating motor symptoms in Parkinson's disease (PD). Few studies have been performed reporting the effects of rTMS on non-motor symptoms such as depression and apathy in PD.
We assessed the effects of high-frequency (HF) rTMS over the primary motor (M1) foot area on motor symptoms, depression and apathy scales, and sensory symptoms in PD.
We investigated the efficacy of 3 consecutive days of HF-rTMS over the M1 foot area in 21 patients with PD using a randomized, double-blind cross-over trial compared with sham stimulation. Motor effects were evaluated using the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the self-assessment motor score, the visual analog scale (VAS), the 10-m walking test, and finger tapping. Non-motor effects were analyzed using the Montgomery Asberg Depression Rating Scale, the Apathy Scale, and quantitative sensory testing.
HF-rTMS significantly improved UPDRS-III (P < 0.001), VAS (P < 0.001), the walking test (P = 0.014), self-assessment motor score (P = 0.010), and finger tapping measurement (P < 0.05) compared to sham stimulation. In contrast, no significant improvement was observed in depression and apathy scales. Consecutive days of rTMS did not significantly increase the improvement in motor symptoms. There were no adverse effects following rTMS on patients with PD.
We confirmed that HF-rTMS over the M1 foot area significantly improved motor symptoms in patients with PD. In addition, daily repeated stimulation was not significantly more effective than a single session of stimulation, but may be effective for maintaining the improvement in motor symptoms in patients with PD.
重复经颅磁刺激（rTMS）已被报道对治疗帕金森病（PD）的运动症状具有临床疗效。很少有研究报告 rTMS 对 PD 的非运动症状（如抑郁和淡漠）的影响。
我们评估了高频（HF）rTMS 对初级运动（M1）足部区域对 PD 患者的运动症状、抑郁和淡漠量表以及感觉症状的影响。
我们采用随机、双盲交叉试验，比较了 21 例 PD 患者连续 3 天接受 M1 足部区域 HF-rTMS 与假刺激的疗效。使用统一帕金森病评定量表第三部分（UPDRS-III）、自我评估运动评分、视觉模拟量表（VAS）、10 米步行测试和手指敲击来评估运动效果。使用蒙哥马利抑郁评定量表、淡漠量表和定量感觉测试来分析非运动效果。
与假刺激相比，HF-rTMS 显著改善了 UPDRS-III（P<0.001）、VAS（P<0.001）、步行测试（P=0.014）、自我评估运动评分（P=0.010）和手指敲击测量（P<0.05）。相比之下，抑郁和淡漠量表没有显著改善。连续几天的 rTMS 并没有显著增加运动症状的改善。rTMS 对 PD 患者没有不良反应。
我们证实了 M1 足部区域的 HF-rTMS 显著改善了 PD 患者的运动症状。此外，每日重复刺激并不比单次刺激更有效，但可能对维持 PD 患者运动症状的改善有效。
