Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurology, Suqian First Hospital, Suqian, China.
Sleep Med. 2022 Dec;100:133-138. doi: 10.1016/j.sleep.2022.08.003. Epub 2022 Aug 11.
Excessive daytime sleepiness (EDS) is a common sleep disorder in Parkinson's disease (PD), which seriously affects patients' quality of life. Repetitive transcranial magnetic stimulation (rTMS) can be used as an add-on therapy to a variety of non-motor symptoms of PD. However, little is known on the treatment of EDS in PD patients.
To explore the effects of low frequency rTMS over right dorsolateral prefrontal cortex (DLPFC) in the treatment of EDS in PD.
We conducted a sham-controlled, parallel study including 25 individuals of PD with possible EDS based on Epworth Sleepiness Scale (ESS ≥8 points) and randomly divided them into active group (n = 15) and sham group (n = 10). 1 Hz rTMS was administrated over right DLPFC for 10 consecutive days. In the active group, we further classified them into responsive group and non-responsive group according to change of ESS score in comparison with baseline. Clinical assessments on motor and non-motor symptoms were completed at baseline, at the end of treatment and 1 month after treatment.
Compared to baseline, active group showed significant improvement on ESS score 10 days and 1 month after treatment (P < 0.05 for both). The percentage change of ESS score was positively related to disease duration during follow-up. No significant changes were observed on ESS score change in the sham group. Further analysis of individuals in the active group showed that, relative to those with non-response to rTMS, individuals with therapeutic response exhibited longer disease duration and lower baseline levodopa equivalent dose.
Low frequency rTMS over right DLPFC may improve symptoms of EDS in PD.
日间过度嗜睡（EDS）是帕金森病（PD）的一种常见睡眠障碍，严重影响患者的生活质量。重复经颅磁刺激（rTMS）可作为 PD 各种非运动症状的附加治疗方法。然而，对于 PD 患者 EDS 的治疗知之甚少。
探讨低频 rTMS 对右侧背外侧前额叶皮质（DLPFC）治疗 PD 患者 EDS 的疗效。
我们进行了一项假对照、平行研究，纳入 25 名基于 Epworth 嗜睡量表（ESS≥8 分）可能患有 EDS 的 PD 患者，并随机分为活动组（n=15）和假刺激组（n=10）。1Hz rTMS 连续 10 天作用于右侧 DLPFC。在活动组中，我们根据 ESS 评分与基线相比的变化，进一步将其分为反应组和非反应组。在基线、治疗结束时和治疗结束后 1 个月进行运动和非运动症状的临床评估。
与基线相比，活动组在治疗后 10 天和 1 个月时 ESS 评分均有显著改善（均 P<0.05）。ESS 评分的变化百分比与随访期间的疾病持续时间呈正相关。假刺激组 ESS 评分无明显变化。对活动组个体的进一步分析表明，与 rTMS 无反应者相比，有治疗反应者的疾病持续时间更长，基线左旋多巴等效剂量更低。
右侧 DLPFC 低频 rTMS 可能改善 PD 患者的 EDS 症状。
