Department of Neurology, Tokushima National Hospital, National Hospital Organization, Yoshinogawa, Tokushima, Japan.
Department of Rehabilitation, Tokushima National Hospital, National Hospital Organization, Yoshinogawa, Tokushima, Japan.
J Neurol Neurosurg Psychiatry. 2014 Nov;85(11):1221-6. doi: 10.1136/jnnp-2014-307651. Epub 2014 Apr 29.
Spinal cord stimulation is a potential therapeutic option for the treatment of Parkinson's disease (PD)-associated symptoms. Repetitive trans-spinal magnetic stimulation (rTSMS) is a non-invasive and safe alternative for stimulation of spinal pathways that has not been studied for therapeutic efficacy in PD. We assessed the benefits of rTSMS on camptocormia, an often treatment-resistant postural abnormality observed in PD patients.
We compared rTSMS to sham stimulation in PD patients with camptocormia in a single-centre, randomised, single-blind, crossover, placebo-controlled study. PD patients with camptocormia were administered a single trial of rTSMS (a train of 40 stimuli) or sham treatment followed 1 week later by the alternate treatment. Primary outcome measure was thoracolumbar spine flexion angle in the standing position immediately after the trial.
Of 320 PD patients examined, 37 had concomitant camptocormia and were randomly assigned to either the rTSMS first group (n=19) or sham first group (n=18). Flexion angle in the standing position decreased by a mean of 10.9° (95% CI 8.1 to 13.65) after rTSMS but remained unchanged after sham stimulation (mean, -0.1°; 95% CI -0.95 to 0.71). The flexion angle while sitting (secondary outcome) decreased by 8.1° (95% CI 5.89 to 10.25) after rTSMS, whereas sham treatment had no significant effect (mean, -0.8°; 95% CI -1.62 to 0.05).
We found an immediate beneficial effect of rTSMS on camptocormia in PD patients. Although the effect was transient, this successful trial justifies further studies to test if repeated rTSMS treatments can induce longer term improvements in camptocormia associated with PD.
UMIN Clinical Trials Registry: UMIN000011495.
脊髓刺激是治疗帕金森病（PD）相关症状的一种潜在治疗选择。重复经颅磁刺激（rTSMS）是一种非侵入性和安全的替代刺激脊髓通路的方法，尚未研究其在 PD 中的治疗效果。我们评估了 rTSMS 对驼背的益处，驼背是 PD 患者中经常出现的一种治疗抵抗性姿势异常。
我们在一项单中心、随机、单盲、交叉、安慰剂对照研究中，将 rTSMS 与假刺激进行比较，纳入了患有驼背的 PD 患者。患有驼背的 PD 患者接受单次 rTSMS 治疗（40 次刺激的一个疗程）或假治疗，1 周后接受交替治疗。主要结局测量指标为试验后立即站立位时胸腰椎的弯曲角度。
在 320 名接受检查的 PD 患者中，有 37 名患者同时患有驼背，并被随机分配到 rTSMS 组（n=19）或假刺激组（n=18）。rTSMS 治疗后，站立位时的弯曲角度平均降低 10.9°（95%CI 8.1 至 13.65），而假刺激后保持不变（平均，-0.1°；95%CI-0.95 至 0.71）。rTSMS 治疗后，坐姿时的弯曲角度（次要结局）降低 8.1°（95%CI 5.89 至 10.25），而假刺激治疗无显著效果（平均，-0.8°；95%CI-1.62 至 0.05）。
我们发现 rTSMS 对 PD 患者的驼背有即时的有益效果。虽然效果是短暂的，但这项成功的试验证明了进一步研究的合理性，以测试重复 rTSMS 治疗是否可以改善与 PD 相关的驼背。
UMIN 临床试验注册：UMIN000011495。
