Niimi Masachika, Fujita Yuko, Ishima Tamaki, Hashimoto Kenji, Sasaki Nobuyuki, Hara Takatoshi, Yamada Naoki, Abo Masahiro
Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Department of Rehabilitation Medicine, Tokyo General Hospital, Tokyo, Japan.
Acta Neuropsychiatr. 2020 Jan 29:1-22. doi: 10.1017/neu.2020.4.
Abnormalities in neurotransmission via N-methyl-D-aspartic acid receptor (NMDAR) play a role in the pathophysiology of neuropsychiatric disorders. The impact of repetitive transcranial magnetic stimulation (rTMS) on NMDAR-related amino acids remains unknown. We aim to investigate the effects of rTMS on NMDAR-related amino acids in serum of post-stroke patients.
Ninety-five consecutive post-stroke patients with upper limb hemiparesis were recruited. In 27 patients, the Beck Depression Inventory (BDI) score was 10 or higher. Twelve depressed patients underwent rehabilitation in combination with rTMS and 15 non-depressed patients underwent rehabilitation only without rTMS for 14 days. 1 Hz rTMS was applied to the primary motor area in the non-lesional hemisphere. BDI was conducted before and after treatment. Serum glutamine, glutamate, glycine, L-serine, and D-serine levels were measured before and after treatment.
There were no differences between depressed patients and non-depressed patients in clinical characteristics, levels of the five amino acids in serum, and the ratio of amino acids. However, in 27 depressed patients there was a significant correlation between levels of glutamate in serum and BDI (ρ=0.428、p=0.026). BDI decreased significantly in depressed patients after treatment with or without rTMS. D-serine decreased in the rehabilitation with rTMS group, but increased in the rehabilitation without rTMS group. L-serine increased in the rehabilitation with rTMS group, but decreased in the rehabilitation without rTMS group.
The results suggest that rTMS can modulate NMDAR-related amino acids in blood, producing beneficial effects.
通过N-甲基-D-天冬氨酸受体（NMDAR）的神经传递异常在神经精神疾病的病理生理学中起作用。重复经颅磁刺激（rTMS）对NMDAR相关氨基酸的影响尚不清楚。我们旨在研究rTMS对中风后患者血清中NMDAR相关氨基酸的影响。
连续招募95例中风后上肢偏瘫患者。27例患者的贝克抑郁量表（BDI）评分≥10分。12例抑郁患者接受康复治疗联合rTMS，15例非抑郁患者仅接受康复治疗，为期14天。1Hz的rTMS应用于非病变半球的初级运动区。治疗前后进行BDI评估。治疗前后检测血清谷氨酰胺、谷氨酸、甘氨酸、L-丝氨酸和D-丝氨酸水平。
抑郁患者与非抑郁患者在临床特征、血清中5种氨基酸水平及氨基酸比值方面无差异。然而，27例抑郁患者血清谷氨酸水平与BDI之间存在显著相关性（ρ=0.428，P=0.026）。抑郁患者在接受或未接受rTMS治疗后BDI均显著降低。rTMS康复组D-丝氨酸降低，未接受rTMS康复组D-丝氨酸升高。rTMS康复组L-丝氨酸升高，未接受rTMS康复组L-丝氨酸降低。
结果表明，rTMS可调节血液中NMDAR相关氨基酸，产生有益作用。
