Treatment Of Low Frequency Rtms On Parkinson′s Disease

Objective: Parkinson's disease (PD) is a major neurodegenerative disease in elderly people characterized by bradykinesia, resting tremor, muscular rigidity, and gait disturbance. Up to date, the unknown etiology of PD has made it difficult to develop a perfect therapeutic strategy. This study was to reveal the MEP and its influential factors in Parkinson's disease from motor function and electrophysiology. To investigated the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) on motor functions , the excitability of the motor cortex and affective disorder in PD and to study mechanism of PD from the eletrophysiology.Methods:①According to inclusion criteria and exclusion criteria, 68 PD patients were selected. Motor evoked potential (MEP) was observed in 68 PD patients and 30 gender-age matched normal control subjects and the difference between two groups were recorded. Adoption of Unified Parkinson's Disease Rating Scale (UPDRS) and MEP as assessment indicators. Excitability of the motor cortex were assessed by rest motor threshold (RMT) , central motor conduction time (CMCT) and amplitude of MEP.②28 patients with PD were performed by 1Hz rTMS therapy to 15 days. (the rTMS protocol : stimulation site was the first motor cortex hand area M1Hand, and the magnetic field strength was 120% resting threshold, each sequence has 20 pulses, and sequence interval was 60 s, three sequences, a total of 60 second pulses were given every day). Adoption of UPDRS, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and MEP as assessment indicators. Excitability of the motor cortex were assessed by RMT, CMCT and amplitude of MEP. All data (x±s) indicated by the mean value±standard deviation that with the SPSS11.5 statistics software analysis, all statistical result has statistics significance standard by P<0.05 as the judgment difference. Results:①MEP changes in PD patients: RMT (41.99±4.72) and CMCT (7.55±1.07) of PD patients were significantly reduced or shortened compared with normal control group RMT (48.87±5.59), CMCT (8.12±0.89) (P<0.01).Among them, RMT(40.92±5.28) of rigidity-group was shorter than RMT (42.93±3.97) of tremor-group in PD patients, while UPDRS(50.66±16.28) of rigidity-group was higher than UPDRS (31.56±14.98) of tremor-group, which exist in statistically significant difference (P<0.05 or P<0.01).RMT(40.70±4.74) of duration>5 years was shorter than RMT (42.60±4.61) of duration≤5 years in PD patients, which exist in statistically significant difference(P<0.05).②MEP changes in PD patients after being treated by rTMS: RMT (42.70±5.70) of PD patients increased to (45.65±4.53), CMCT (7.53±0.89) be extended to (7.88±0.88), the difference was statistically significant (P <0.01). This changes also exist in different Hoehn-Yahr stages, rigidity-group and tremor-group.③UPDRS changes in PD patients after being treated by rTMS: motor function have improved. UPDRS total score of PD patients was decreased from (44.96±18.22) to (35.04±17.26), UPDRSⅠscore (2.68±1.83) reduced to (1.71±1.54), UPDRSⅡscore (17.07±8.21) reduced to (13.29±7.43), UPDRSⅢscore (24.93±10.18) reduced to (20.11±9.68). Differences were statistically significant (P<0.01). The rigidity-group had more obvious improvement. Reduce of UPDRS total score (44.96±18.22) of rigidity-group was more significant than the lower of tremor-group, the difference was statistically significant (P <0.05).④HAMD and HAMA changes in PD patients after being treated by rTMS: HAMD score was decreased from (12.53±7.68) to (10.25±7.84) (P<0.01). The rigidity PD patients had more obvious improvement. In which the Somatization of HAMD score (2.75±1.67) reduced to (2.29±1.94), block score (1.86±1.69) reduced to (1.03±1.45), sleep factor score (1.64±1.83) reduced to (1.11±1.50), the difference was statistically significant. (P<0.05).HAMA score had no significant change in in PD patients after being treated by rTMS(P>0.05).Conclusion:①PD patients had motor dysfunction, and their cerebral cortex excitability increased; rigidity-group and longer course of illness in patients had more serious illness, and the brain cortex excitability increased more apparent.②Low-frequency rTMS can improve motor dysfunction in PD patients, and it could partly inhibit the increase in the cerebral cortex excitability changes. And the low-frequency rTMS to the severity of the different PD patients were effective, the symptoms of rigidity and tremor have therapeutic effect, and the type of rigidity is better than the tremor type.③Low-frequency rTMS can improve depressive symptoms in patients with PD, no significant effect on anxiety.