Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease A randomized trial
Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease A randomized trial
复制标题
DOI：
10.1212/wnl.0000000000003279
复制
发表时间：
2016-11-01
期刊：
影响因子：
9.9
通讯作者：
Pascual-Leone, Alvaro
中科院分区：
文献类型：
--
作者：
Brys, Miroslaw;Fox, Michael D.;Pascual-Leone, Alvaro
目的：评价多焦点、高频重复的运动和前额叶皮质经颅磁刺激(RTMS)对帕金森病(PD)患者运动和情绪症状的改善作用。方法：采用多中心、双盲、假对照、平行分组的真实或现实(电)假rTMS研究。患者被随机分为4组：双侧M1组(1个假手术组)、DLPFC组(1个假手术组)、M1组(1个DLPFC组)或双侧假手术组。TMS疗程包括10次每日10次，左侧DLPFC有2000个刺激，每个M1有1000个刺激(50个3-4秒的40个刺激在10赫兹)。患者在治疗前、治疗后1周、治疗后1、3和6个月进行评估。主要终点是在1个月时用统一的帕金森病评定量表-III评估运动功能的变化和用汉密尔顿抑郁量表评估情绪的变化。结果：计划招募的160名患者中，85名通过筛查，61名随机选择，50名完成所有研究访问。在主要终点，真正的M1 rTMS比Sham有更大的运动功能改善(p<；0.05)。与双假手术组相比，DLPFC组的情绪没有改善，M1和DLPFC联合刺激对运动和情绪症状都没有好处。结论：在PD伴抑郁的患者中，M1 rTMS是一种有效的运动症状治疗方法，而DLPFC rTMS治疗2周后的情绪改善效果并不比Sham好。在每个rTMS会话中同时针对M1和DLPFC没有显示出协同效应的证据。ClinicalTrials.gov标识符：NCT01080794。证据分类：这项研究提供了I类证据，表明在患有抑郁症的PD患者中，M1 rTMS导致运动功能的改善，而DLPFC rTMS与假rTMS相比并不导致抑郁的改善。
Objective: To assess whether multifocal, high-frequency repetitive wtranscranial magnetic stimulation (rTMS) of motor and prefrontal cortex benefits motor and mood symptoms in patients with Parkinson disease (PD).Methods: Patients with PD and depression were enrolled in this multicenter, double-blind, sham-controlled, parallel-group study of real or realistic (electric) sham rTMS. Patients were randomized to 1 of 4 groups: bilateral M1 (1 sham dorsolateral prefrontal cortex [DLPFC]), DLPFC (1 sham M1), M1 1 DLPFC, or double sham. The TMS course consisted of 10 daily sessions of 2,000 stimuli for the left DLPFC and 1,000 stimuli for each M1 (50 3 4-second trains of 40 stimuli at 10 Hz). Patients were evaluated at baseline, at 1 week, and at 1, 3, and 6 months after treatment. Primary endpoints were changes in motor function assessed with the Unified Parkinson's Disease Rating Scale-III and in mood with the Hamilton Depression Rating Scale at 1 month.Results: Of the 160 patients planned for recruitment, 85 were screened, 61 were randomized, and 50 completed all study visits. Real M1 rTMS resulted in greater improvement in motor function than sham at the primary endpoint (p < 0.05). There was no improvement in mood in the DLPFC group compared to the double-sham group, as well as no benefit to combining M1 and DLPFC stimulation for either motor or mood symptoms.Conclusions: In patients with PD with depression, M1 rTMS is an effective treatment of motor symptoms, while mood benefit after 2 weeks of DLPFC rTMS is not better than sham. Targeting both M1 and DLPFC in each rTMS session showed no evidence of synergistic effects.ClinicalTrials.gov identifier: NCT01080794.Classification of evidence: This study provides Class I evidence that in patients with PD with depression, M1 rTMS leads to improvement in motor function while DLPFC rTMS does not lead to improvement in depression compared to sham rTMS.