Institute of Neurorehabilitation, Sopron, Hungary.
Semmelweis University, Digital Health Department, Budapest, Hungary.
Brain Res Bull. 2017 Oct;135:98-104. doi: 10.1016/j.brainresbull.2017.10.002. Epub 2017 Oct 5.
rTMS may influence on both cognitive and motor function in PD but the daily routine and the predictors of responders to rTMS are not known.
OBJECTIVE/HYPOTHESIS: We hypothesized that the frequency and intensity of stimulation somehow relate to each other. Our goal was to select the optimal frequency with low intensity for PD. We clarified the importance of age in the effect of rTMS.
A total sixty-six patients with PD were included in the study. In an open investigation, randomly selected patients were divided into three groups. The effects of 1Hz (N=28), 5Hz (N=13) and 5+1Hz (N=25) frequency at low intensity over each DLPFC and the brain stem for 7days were compared. Patients were followed for six months. UPDRS, the Trail Making Test, and dual tasks were applied. Patients ≤65years >65yrs were compared. Data were analyzed by repeated measure ANOVA.
Only 1Hz had an effect on motor scores. Before the trial patients≤65 yrs had UPDRS total scores of 30.3±16.9, after 1 month: 17.8±8.9 p<0.001, after 6 months 18.3±8.8 p<0.001. Improvement of patients >65yrs was observed after one month (p<0.01). Executive function >65yrs (N=16) was significantly worse compared with C (N=15) and it was improved temporarily by 1Hz. Five Hertz and 5+1Hz did not cause improvement.
One Hertz with proper intensity has a good outcome in PD. Patients >65yrs show deterioration in their executive function and they have shorter duration in their therapeutic effect of rTMS. This study draws attention to the importance of stimulation intensity and age as a predictor of the effect of rTMS.
rTMS 可能会影响 PD 患者的认知和运动功能，但目前尚不清楚 rTMS 的日常常规以及对其有反应的预测因素。
目的/假设：我们假设刺激的频率和强度之间存在某种关系。我们的目标是为 PD 选择最佳的低强度频率。我们阐明了年龄在 rTMS 效应中的重要性。
共有 66 名 PD 患者纳入本研究。在一项开放性研究中，随机选择的患者被分为三组。比较了低强度下 1Hz（N=28）、5Hz（N=13）和 5+1Hz（N=25）频率对 DLPFC 和脑干的 7 天影响。患者随访 6 个月。应用 UPDRS、TMT 和双重任务。比较患者≤65 岁和>65 岁。数据采用重复测量方差分析进行分析。
只有 1Hz 对运动评分有影响。在试验前，患者≤65 岁时 UPDRS 总分为 30.3±16.9，1 个月后为 17.8±8.9（p<0.001），6 个月后为 18.3±8.8（p<0.001）。>65 岁患者仅在 1 个月后观察到改善（p<0.01）。>65 岁患者的执行功能（N=16）明显比 C 组（N=15）差，1Hz 可暂时改善。5Hz 和 5+1Hz 没有改善。
适当强度的 1Hz 在 PD 中有良好的效果。>65 岁的患者执行功能恶化，rTMS 的治疗效果持续时间更短。本研究提醒人们注意刺激强度和年龄作为 rTMS 效应预测因素的重要性。
