Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease
Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease
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DOI：
10.1016/j.clinph.2004.05.025
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发表时间：
2004-11-01
影响因子：
4.7
通讯作者：
Nguyen, JP
中科院分区：
文献类型：
--
作者：
Lefaucheur, JP;Drouot, X;Nguyen, JP
目的：目的：探讨运动皮层局灶性刺激对帕金森病（PD）患者运动功能和皮层兴奋性的影响。方法：对12例“停药”的PD患者进行重复经颅磁刺激（rTMS）。使用“真实的”或“假”线圈，在0.5 Hz（600个脉冲）或10 Hz（2000个脉冲）下应用阈下rTMS的效果与单剂量1-多巴获得的效果进行比较。该评估包括一个统一的帕金森氏病评定量表和定时运动任务的临床评价，和神经生理学评价皮层兴奋性的单脉冲和成对脉冲TMS techniques.Results：“真实的”rTMS在10或0.5 Hz，但不是“假”刺激，提高运动性能。高频rTMS减少刺激对侧上肢的僵硬和运动迟缓，而低频rTMS减少双侧上肢僵硬并改善行走。同时，10 Hz的rTMS增加皮层内的便利，而0.5 Hz的rTMS恢复intracorticalinhibitory.Conclusions：低和高频率的rTMS的初级运动皮层导致显着的，但差异的变化，PD患者的临床和电生理的理由。对皮质兴奋性的影响与以前在健康受试者中观察到的结果相反，表明与正常人相比，PD患者的皮质兴奋性存在反向平衡。然而，这些变化的潜在机制仍有待确定，以及与临床表现和1-dopatherapy.Significance反应的关系：本研究提供了一些线索，以评估初级运动皮层在PD中的作用。rTMS诱导的临床改善持续时间太短，无法考虑治疗应用，但这些结果支持初级运动皮层作为PD神经调节的可能靶点的观点。(C)2004年国际临床神经生理学联合会。由Elsevier爱尔兰有限公司出版。保留所有权利。
Objective: To assess the effects of focal motor cortex stimulation on motor performance and cortical excitability in patients with Parkinson's disease (PD).Methods: Repetitive transcranial magnetic stimulation (rTMS) was performed on the left motor cortical area corresponding to the right hand in 12 'off-drug' patients with PD. The effects of subthreshold rTMS applied at 0.5 Hz (600 pulses) or at 10 Hz (2000 pulses) using a 'real' or a 'sham' coil were compared to those obtained by a single dose of 1-dopa. The assessment included a clinical evaluation by the Unified Parkinson's Disease Rating Scale and timed motor tasks, and a neurophysiological evaluation of cortical excitability by single- and paired-pulse TMS techniques.Results: 'Real' rTMS at 10 or 0.5 Hz, but not 'sham' stimulation, improved motor performance. High-frequency rTMS decreased rigidity and bradykinesia in the upper limb contralateral to the stimulation, while low-frequency rTMS reduced upper limb rigidity bilaterally and improved walking. Concomitantly, 10 Hz rTMS increased intracortical facilitation, while 0.5 Hz rTMS restored intracortical inhibition.Conclusions: Low- and high-frequency rTMS of the primary motor cortex lead to significant but differential changes in patients with PD both on clinical and electrophysiological grounds. The effects on cortical excitability were opposite to previous observations made in healthy subjects, suggesting a reversed balance of cortical excitability in patients with PD compared to normals. However, the underlying mechanisms of these changes remain to determine, as well as the relationship with clinical presentation and response to 1-dopa therapy.Significance: The present study gives some clues to appraise the role of the primary motor cortex in PD. Clinical improvement induced by rTMS was too short-lasting to consider therapeutic application, but these results support the perspective of the primary motor cortex as a possible target for neuromodulation in PD. (C) 2004 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.