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重复经颅磁刺激治疗脑卒中后癫痫的疗效及其对患者认知功能和抑郁状态的影响。

Efficacy of rTMS for poststroke epilepsy and its effects on patients' cognitive function and depressive status.

机构信息

Department of Neurology, The Second People's Hospital of Nanning, Nanning, China.

出版信息

BMC Neurol. 2024 Jan 12;24(1):25. doi: 10.1186/s12883-024-03531-4.

Abstract

OBJECTIVE

This study aimed to investigate the efficacy of rTMS in the treatment of poststroke epilepsy and the effect of rTMS on patients' cognitive function and depressive status.

METHODS

One hundred and twenty-one poststroke epilepsy patients with mild cognitive impairment and depressive status admitted to the Department of Neurology of the Second People's Hospital of Nanning from January 1, 2017, to April 31, 2023, were selected and divided into the rTMS treatment group (treated group) and the control group. MMSE scores and HAMD scores were recorded before and after treatment. The frequency of EEG spiky waves recorded before and after treatment within 24 h and the frequency of any clinical seizure form (the number of clinical seizures within 1 month after treatment) and changes in observed indices before and after treatment were calculated. The differences between the data of the two groups were analyzed, to further assess the efficacy of rTMS in the treatment of poststroke epilepsy and the rTMS' effects on cognition and depression.

RESULTS

Compared with drug treatment alone, rTMS significantly decreased clinical seizures and epileptiform discharges after stroke, especially in patients with lesions in the frontal, temporal, and parietal lobes. Compared with drug treatment alone, rTMS treatment can effectively reduce cognitive impairment and mood disorders, such as depression, especially for patients with lesions in the frontal and temporal lobes. The results of this experiment suggest that rTMS treatment does not increase adverse effects.

CONCLUSION

rTMS reduces clinical seizures while improving cognitive impairment and depression in patients with epilepsy. Therefore, we suggest that low-frequency rTMS can be used as an adjunctive treatment for patients with epilepsy and provide some ideas and references for the treatment of epilepsy with cognitive impairment and depression.

摘要

目的

本研究旨在探讨重复经颅磁刺激(rTMS)治疗脑卒中后癫痫的疗效,以及 rTMS 对患者认知功能和抑郁状态的影响。

方法

选取 2017 年 1 月 1 日至 2023 年 4 月 31 日在南宁市第二人民医院神经内科收治的 121 例伴有轻度认知障碍和抑郁状态的脑卒中后癫痫患者,分为 rTMS 治疗组(治疗组)和对照组。记录治疗前后的简易精神状态检查表(MMSE)评分和汉密尔顿抑郁量表(HAMD)评分。治疗前后 24 h 内记录脑电图棘波频率,以及治疗后 1 个月内任何临床发作形式的频率(治疗后临床发作次数)和观察指标的变化。分析两组数据的差异,进一步评估 rTMS 治疗脑卒中后癫痫的疗效,以及 rTMS 对认知和抑郁的影响。

结果

与单纯药物治疗相比,rTMS 可显著减少脑卒中后临床发作和癫痫样放电,尤其是在额叶、颞叶和顶叶病变患者中。与单纯药物治疗相比,rTMS 治疗可有效减轻认知障碍和情绪障碍,如抑郁,尤其是在额叶和颞叶病变患者中。本实验结果提示 rTMS 治疗不会增加不良反应。

结论

rTMS 可减少临床发作,同时改善癫痫患者的认知障碍和抑郁。因此,我们建议低频 rTMS 可作为癫痫患者的辅助治疗手段,为伴有认知障碍和抑郁的癫痫治疗提供一些思路和参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c46/10785375/dba554cae368/12883_2024_3531_Fig1_HTML.jpg

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