Clinical and neurophysiologival efficacy of transcranial magnetic stimulation treatment in patients with stage II Parkinson's disease

A. Demchenko, Djamilia Aravitska
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Abstract

Summary. The aim of our study was to determine the clinical and neurophisiological effectiveness of transcranial magnetic stimulation treatment in patients with stage II Parkinson's disease (PD). Materials and methods. The prospective randomised placebo-controlled study included 90 patients aged 49 to 75 years with stage II PD according to Hoehn-Yahr. All patients were randomized to two groups of 45 in each for a TMS course: group 1 included patients assigned to a real TMS course, while group 2 included placebo TMS sessions. All patients on the background of basic PD therapy were additionally prescribed a course of therapeutic TMS sessions according to the protocol in zones C3, C4 and Cz of the brain (projection of the premotor cortex according to the international system 10-20%) with a pulse frequency in the series of 5 Hz and a total number of pulses of 2000 per session. During the study, patients were examined twice: at the beginning and at the end of TMS sessions. Examination of patients was performed according to the following scheme: clinical and neurological examination using SPES SCOPA Motor scale and neurophysiological examination to determine the latency, amplitude, area and duration of motor evoked potential (MEP) after 2 tests with a gradual increase of magnetic field induction. Results. TMS treatment resulted in a significant reduction in MEP latency (p<0,001) in patients from with real TMS group, while it was found no reduction in MEP latency (p> 0,05) in placebo-TMS patients. The amplitude of the MEP of the left and right premotor cortex did not change significantly either in the group with real TMS (p>0,05) or in the group of placebo-TMS (p>0,05). The duration of MEP increased significantly (p <0,001) after the course of TMS, and in the placebo-TMS group no significant changes were found (p> 0,05). Conclusions. Treatment with TMS leads to a clinical reduction in the manifestations of motor symptoms of PD using the SPES SCOPA Motor scale score, namely to a decrease in the amplitude of rest and postural tremor, bradykinesia, rigidity and gait disorders. Also TMS leads to a significant decrease in the latent period of MEP and increase the duration of MEP.
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经颅磁刺激治疗II期帕金森病患者的临床和神经生理疗效
总结。本研究的目的是确定经颅磁刺激治疗II期帕金森病(PD)患者的临床和神经生理学有效性。材料和方法。根据Hoehn-Yahr的说法,这项前瞻性随机安慰剂对照研究包括90名年龄在49至75岁之间的II期PD患者。所有患者被随机分为两组,每组45人进行一次经颅磁刺激疗程:第一组患者接受真正的经颅磁刺激疗程,而第二组患者接受安慰剂性经颅磁刺激疗程。所有接受PD基础治疗的患者根据方案在大脑C3、C4和Cz区(根据国际系统10-20%运动前皮层的投影)进行一个疗程的TMS治疗,脉冲频率为5 Hz,每次脉冲总数为2000次。在研究期间,患者接受了两次检查:在TMS治疗的开始和结束时。采用SPES SCOPA运动量表对患者进行临床和神经学检查,经2次试验测定运动诱发电位(MEP)潜伏期、幅度、面积和持续时间,磁场感应逐渐增强。结果。经颅磁刺激治疗显著降低了安慰剂组患者的MEP潜伏期(p < 0.05)。真实经颅磁刺激组和安慰剂-经颅磁刺激组左、右运动前皮层MEP振幅均无显著变化(p> 0.05)。MEP持续时间显著增加(p < 0.05)。结论。经颅磁刺激治疗可使帕金森病的运动症状表现(采用SPES SCOPA运动量表评分)在临床有所减少,即休息和体位性震颤、运动迟缓、僵硬和步态障碍的幅度有所减少。经颅磁刺激可显著缩短MEP潜伏期,延长MEP持续时间。
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