Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease
Effects of DBS, Premotor rTMS, and Levodopa on Motor Function and Silent Period in Advanced Parkinson's Disease
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DOI：
10.1002/mds.22417
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发表时间：
2009-04-15
影响因子：
8.6
通讯作者：
Muenchau, Alexander
中科院分区：
文献类型：
--
作者：
Baeumer, Tobias;Hidding, Ute;Muenchau, Alexander
丘脑底核脑深部电刺激（DBS）是治疗晚期帕金森病（PD）患者的一种广泛使用且高效的治疗方法。应用于运动皮层区域的重复经颅磁刺激（rTMS）也已被证明可以改善PD症状和模块运动皮层兴奋性。在这里，我们比较了临床和神经生理学的影响，1 Hz的rTMS给予背侧运动前皮层（PMD）和摄入左旋多巴后，在一组PD患者的晚期疾病的帕金森氏症刺激。10例PD患者在手术前后连续2天进行研究。临床效果采用WESTERS运动评分确定。用经颅磁刺激（TMS）测量运动阈值、轻微随意收缩时运动诱发电位（MEP）幅度和皮层沉默期（SP）。术前左旋多巴和1 Hz PMD rTMS的效果和术后有或没有额外的左旋多巴的电刺激的效果被确定。左旋多巴明显改善临床症状，延长SP持续时间。电刺激可改善临床症状而不改变SP持续时间。相反，1 Hz PMD rTMS在临床上无效，但使SP持续时间正常化。而左旋多巴在PD患者异常活跃的运动网络的不同水平上具有广泛的作用。电刺激和PMd rTMS导致临床改善或SP正常化。即，仅部分逆转异常运动网络活动。(C)2009运动障碍协会
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a widely used and highly effective treatment for patients with advanced Parkinson's disease (PD). Repetitive TMS (rTMS) applied to motor cortical areas has also been shown to improve symptoms in PD and module motor cortical excitability. Here, we compared clinical and neurophysiological effects of STN stimulation with those of 1 Hz rTMS given to the dorsal premotor cortex (PMd) and those following intake of levodopa in a group of PD patients with advanced disease. Ten PD patients were studied on 2 consecutive days before and after surgery. Clinical effects were determined using the UPDRS motor score. Motor thresholds, motor-evoked potential (MEP) amplitudes during slight voluntary contraction, and the cortical silent periods (SP) were measured usingTMS. Before surgery effects of levodopa and 1 Hz PMD rTMS and after surgery those of STN stimulation with or without additional levodopa were determined. Levodopa significantly improved clinical symptoms and increased the SP duration. STN stimulation improved clinical symptoms without changing the SP duration. In contrast, 1 Hz PMD rTMS was not effective clinically but normalized the SP duration. Whereas levodopa had widespread effects at different levels of an abnormally active motor network in PD. STN stimulation and PMd rTMS led to either clinical improvement or SP normalization. i.e.. only partially reversed abnormal motor network activity. (C) 2009 Movement Disorder Society