Institute of Neurorehabilitation, Major-köz 3., Sopron, Hungary.
Institute of Neuroscience, University of Glasgow, Glasgow, G12 8QQ, United Kingdom.
Brain Res Bull. 2018 Sep;142:78-87. doi: 10.1016/j.brainresbull.2018.06.014. Epub 2018 Jun 26.
Transcranial magnetic stimulation (rTMS) may influence the progression of PD compared with levodopa. The long term mind modification effect of repeated rTMS and tDCS is not known, nor are the predictors for the effect of NBS.
OBJECTIVE/HYPOTHESIS: We hypothesized that the regularly repeated rTMS would decrease the development of PD. Later, the treatment protocol was completed with transcranial direct current stimulation (tDCS), supposing that there is an add-on effect. NBS may differently influence motor and mental aspects of the disease.
Thirty patients with PD were followed for 3.5 years in an open study. They were stimulated with 1 Hz rTMS every half year for 1.5 years. After that the tDCS was add to the stimulation over both sides of the cerebellum for the next 2 years. UPDRS, Trail Making Test and dual tests were used. The linear regression lines of score systems and percentage of yearly increment were counted, analyzed by ANOVA.
The yearly progression rate for UPDRS total was 2% for 3.5 years, 0.6% ≤65 years, 3.6% >65 years. The increment was around zero during the rTMS + tDCS stimulations in patients ≤65 years. The slope of the equation showed the same tendency. The individual sensitivity to the NBS was high. tTMS and tDCS >65 yrs improved pathological executive function (p < 0.0001).
The motor ability in PD was maintained at the same level in patients ≤65 years with NBS for the 3.5 years in contrast to patients >65 years. The cognitive function of patients >65 yrs was favorable influenced by rTMS and tDCS. Age is the main predictor of the effect of NBS. rTMS and tDCS can slow the progression of PD without any side effects but in an age-dependent way.
与左旋多巴相比，经颅磁刺激（rTMS）可能会影响 PD 的进展。目前尚不清楚重复 rTMS 和 tDCS 的长期思维改变效果，也不知道 NBS 效果的预测因素。
目的/假设：我们假设定期重复 rTMS 会降低 PD 的发展速度。之后，我们用经颅直流电刺激（tDCS）完成了治疗方案，假设会有附加效果。NBS 可能会以不同的方式影响疾病的运动和精神方面。
30 例 PD 患者在一项开放研究中随访 3.5 年。他们接受了为期 1.5 年、每半年 1Hz rTMS 刺激。之后，在接下来的 2 年中，tDCS 被添加到双侧小脑的刺激中。使用 UPDRS、TMT 和双任务测试。通过 ANOVA 分析，计算和分析评分系统的线性回归线和每年递增的百分比。
3.5 年内 UPDRS 总分的年进展率为 2%，65 岁以下为 0.6%，65 岁以上为 3.6%。在≤65 岁的患者中，rTMS+tDCS 刺激期间，增加量接近零。方程的斜率也表现出相同的趋势。个体对 NBS 的敏感性很高。rTMS 和 tDCS >65 岁可改善病理性执行功能（p<0.0001）。
与>65 岁的患者相比，NBS 治疗 3.5 年后，≤65 岁的患者的运动能力保持在同一水平。>65 岁患者的认知功能受到 rTMS 和 tDCS 的有利影响。年龄是 NBS 效果的主要预测因素。rTMS 和 tDCS 可以在不产生任何副作用的情况下，但以年龄依赖的方式减缓 PD 的进展。
