Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain.
Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain.
J Neuroeng Rehabil. 2024 Aug 5;21(1):135. doi: 10.1186/s12984-024-01427-5.
BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) and EEG-guided neurofeedback techniques can reduce motor symptoms in Parkinson's disease (PD). However, the effects of their combination are unknown. Our objective was to determine the immediate and short-term effects on motor and non-motor symptoms, and neurophysiological measures, of rTMS and EEG-guided neurofeedback, alone or combined, compared to no intervention, in people with PD. METHODS: A randomized, single-blinded controlled trial with 4 arms was conducted. Group A received eight bilateral, high-frequency (10 Hz) rTMS sessions over the Primary Motor Cortices; Group B received eight 30-minute EEG-guided neurofeedback sessions focused on reducing average bilateral alpha and beta bands; Group C received a combination of A and B; Group D did not receive any therapy. The primary outcome measure was the UPDRS-III at post-intervention and two weeks later. Secondary outcomes were functional mobility, limits of stability, depression, health-related quality-of-life and cortical silent periods. Treatment effects were obtained by longitudinal analysis of covariance mixed-effects models. RESULTS: Forty people with PD participated (27 males, age = 63 ± 8.26 years, baseline UPDRS-III = 15.63 ± 6.99 points, H&Y = 1-3). Group C showed the largest effect on motor symptoms, health-related quality-of-life and cortical silent periods, followed by Group A and Group B. Negligible differences between Groups A-C and Group D for functional mobility or limits of stability were found. CONCLUSIONS: The combination of rTMS and EEG-guided neurofeedback diminished overall motor symptoms and increased quality-of-life, but this was not reflected by changes in functional mobility, postural stability or depression levels. TRIAL REGISTRATION: NCT04017481.
背景:重复经颅磁刺激(rTMS)和基于脑电图的神经反馈技术可减轻帕金森病(PD)的运动症状。然而,其联合应用的效果尚不清楚。我们的目的是确定 rTMS 和基于脑电图的神经反馈单独或联合应用与不干预相比,对 PD 患者的运动和非运动症状以及神经生理指标的即刻和短期影响。
方法:进行了一项随机、单盲对照试验,共分为 4 组。A 组接受 8 次双侧高频(10 Hz)rTMS 治疗,刺激部位为初级运动皮质;B 组接受 8 次 30 分钟的基于脑电图的神经反馈治疗,重点是降低双侧平均 alpha 和 beta 频段;C 组接受 A 和 B 的联合治疗;D 组未接受任何治疗。主要结局测量指标为干预后和两周后的 UPDRS-III。次要结局指标为功能性移动能力、稳定性极限、抑郁、健康相关生活质量和皮质静息期。采用纵向协方差混合效应模型进行治疗效果的分析。
结果:共有 40 名 PD 患者(27 名男性,年龄 63 ± 8.26 岁,基线 UPDRS-III 为 15.63 ± 6.99 分,H&Y 为 1-3)参与了研究。C 组在运动症状、健康相关生活质量和皮质静息期方面的改善效果最大,其次是 A 组和 B 组。A-C 组和 D 组之间在功能性移动能力或稳定性极限方面没有发现明显差异。
结论:rTMS 和基于脑电图的神经反馈联合应用可减轻整体运动症状,提高生活质量,但这并未反映在功能性移动能力、姿势稳定性或抑郁水平的变化上。
试验注册:NCT04017481。
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