Liu Chunyan, Dai Zhengjia, Zhang Ruihua, Zhang Mo, Hou Yue, Qi Zhigang, Huang Zhaoyang, Lin Yicong, Zhan Shuqin, He Yong, Wang Yuping
Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neuromodulation, Beijing, China.
State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China; Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China.
Sleep Med. 2015 Jun;16(6):785-91. doi: 10.1016/j.sleep.2014.12.029. Epub 2015 Mar 20.
The objectives of this study were, first, to explore differences in brain activity between normal people and idiopathic restless legs syndrome (RLS) patients during asymptomatic periods; and, second, to determine whether administering repetitive transcranial magnetic stimulation (rTMS) to specific cortical regions would reverse any observed differences in brain activity and alleviate patient symptoms.
Fifteen idiopathic RLS patients (nine drug-naive patients) and 14 gender- and age-matched healthy controls were enrolled. Resting-state functional magnetic resonance imaging was used to measure the amplitude of low-frequency fluctuations (ALFF) in spontaneous brain activity during asymptomatic periods. Seven patients received high-frequency (5 Hz) rTMS directed toward the leg area of the primary motor cortex. Scores on the International Restless Legs Syndrome Study Group (IRLSSG) Rating Scale and ALFF values were measured before and after treatment.
Compared with healthy controls, RLS patients showed lower ALFF in the sensorimotor and visual processing regions, and higher ALFF in the insula, parahippocampal and hippocampal gyri, left posterior parietal areas, and brainstem. These results were largely conserved when only drug-naive patients were considered. After rTMS treatment, ALFF in several sensorimotor and visual regions were significantly elevated and IRLSSG Rating Scale scores decreased, indicating improved RLS symptoms.
High-frequency rTMS delivered to the leg area of the primary motor cortex may raise functional activity in the sensorimotor and occipital regions, leading to improve symptoms in RLS patients. These results provide novel insight into RLS pathophysiology and suggest a potential mechanism for rTMS therapy in idiopathic RLS patients.
本研究的目的，其一，是探索正常人及特发性不宁腿综合征（RLS）患者在无症状期大脑活动的差异；其二，是确定对特定皮质区域进行重复经颅磁刺激（rTMS）是否会逆转观察到的大脑活动差异并缓解患者症状。
招募了15名特发性RLS患者（9名未接受过药物治疗的患者）和14名年龄及性别匹配的健康对照者。静息态功能磁共振成像用于测量无症状期自发脑活动中低频波动（ALFF）的幅度。7名患者接受了针对初级运动皮层腿部区域的高频（5Hz）rTMS。在治疗前后测量国际不宁腿综合征研究组（IRLSSG）评分量表得分及ALFF值。
与健康对照者相比，RLS患者在感觉运动和视觉处理区域的ALFF较低，而在岛叶、海马旁回和海马回、左侧顶叶后部区域及脑干的ALFF较高。仅考虑未接受过药物治疗的患者时，这些结果基本保持不变。rTMS治疗后，几个感觉运动和视觉区域的ALFF显著升高，IRLSSG评分量表得分降低，表明RLS症状有所改善。
对初级运动皮层腿部区域进行高频rTMS可能会提高感觉运动和枕叶区域的功能活动，从而改善RLS患者的症状。这些结果为RLS的病理生理学提供了新的见解，并提示了rTMS治疗特发性RLS患者的潜在机制。
