目的 观察中枢联合外周双靶磁刺激治疗帕金森病(Parkinson disease,PD)冻结步态(freezing of gait,FOG)的疗效.方法 纳入2022年7月-2023年9月就诊于南通大学附属医院帕金森专病门诊的39例PD伴冻结步态的患者,按照随机数字表法分为观察组(20例)和对照组(19例).对照组进行重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS),观察组在rTMS基础上增加对患侧胫前肌的重复外周磁刺激(repetitive peripheral magnetic stimulation,rPMS),两组患者其他临床药物治疗方案相同.分别在干预前和干预2周后采用起立行走计时测试(timed up and go test,TUGT)、10 m 步行测试(10 meter walk test,10MWT)和运动诱发电位(motor evoked potentials,MEP)评估两组患者的治疗效果.使用SPSS 25.0进行统计分析,两组间比较采用独立样本t检验,组内治疗前后比较采用配对样本 t 检验.结果 治疗前两组患者TUGT时间、10MWT速度和MEP波幅均差异无统计学意义(t=0.659,0.514,0.345,均P＞0.05).干预后,观察组患者TUGT时间[观察组(7.87±1.74)s,对照组(9.31±1.57)s;t=2.723,P=0.01]和 MEP 波幅[观察组(41.59±14.81)mV,对照组(58.26±19.26)mV;t=3.039,P=0.004]均低于对照组,观察组患者10MWT速度高于对照组[观察组(1.21±0.20)m/s,对照组(1.01±0.17)m/s;t=3.173,P=0.003].治疗后,观察组和对照组患者TUGT时间、MEP波幅均低于治疗前(观察组:t=13.512,7.126,均P＜0.001;对照组:t=6.535,3.094,均P＜0.05),观察组和对照组患者治疗后10MWT速度均高于治疗前(t=25.665,6.750,均P＜0.001).结论 中枢联合外周双靶磁刺激有助于改善PD患者冻结步态,值得临床推广.
Efficacy of central combined peripheral dual-target magnetic stimulation on freezing of gait in Parkinson disease
Objective To explore the efficacy of central combined peripheral dual-target magnetic stimulation on Parkinson disease(PD)patients with freezing of gait(FOG).Methods A total of 39 pa-tients with FOG diagnosed at the Parkinson disease clinic of the Affiliated Hospital of Nantong University were included in the study from July 2022 to September 2023.They were randomly divided into observation group(n=20)and control group(n=19)by the random number table method.The patients in control group were treated with repetitive transcranial magnetic stimulation(rTMS),while the patients in observation group were treated with additional repetitive peripheral magnetic stimulation(rPMS)on the affected tibialis anterior muscle on the basis of the control group.Other clinical medical treatments were the same for both groups of patients.The timed up and go test(TUGT),10 meter walk test(10MWT),and motor evoked po-tentials(MEP)were used to evaluate the efficacy before and after 2 weeks of treatment.The SPSS 25.0 soft-ware was used for statistical analysis.Independent sample t-test was used for comparison between the two groups,and paired sample t-test was used for comparison before and after treatment within group.Results Before treatment,there were no statistically significant difference in TUGT time,10MWT speed and MEP amplitude between the two groups(t=0.659,0.514,0.345,all P＞0.05).After treatment,the TUGT time((7.87±1.74)s vs(9.31±1.57)s)and MEP amplitude((41.59±14.81)mV vs(58.26±19.26)mV)of the observation group were lower than those of the control group(t=2.723,3.039,P=0.010,0.004),while the 10MWT speed of the observation group was higher than that of the control group((1.21±0.20)m/s vs(1.01±0.17)m/s,t=3.173,P=0.003).After treatment,the TUGT time and MEP amplitude of patients in the observation group and control group were all lower than before treatment(obser-vation group:t=13.512,7.126,both P＜0.001;control group:t=6.535,3.094,both P＜0.05).The 10MWT speeds of patients in the observation group and control group after treatment were both higher than before treatment(t=25.665,6.750,both P＜0.001).Conclusion The combination of central and peripheral dual-target magnetic stimulation may improve the FOG of PD patients,and it is worthy of clinical promotion.
Parkinson diseaseFreezing of gaitDual-target magnetic stimulationRepetitive transcranial magnetic stimulationRepetitive peripheral magnetic stimulation
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