| Objective:Through the analysis of the activity of the motor cortex and the subcortical inhibitory intermediate neurons, to study the mechanism of human brain function asymmetry in the pathogenesis of Persistent somatoform pain disorder (PSPD). study the therapeutic mechanism of transcrania magnetic stimulation on PSPD, then compare the curative effect of antidepressant drug combined with rTMS with antidepressant drugs.Method:In strict accordance with the diagnostic criteria, inclusion criteria and peeling out standard screening of 37 cases of PSPD patients,who would be divided into A group and B group according to the randomized principle.20 cases of healthy participants were divided into C group. The B group was treated with Sertraline of SSRI therapy, the A group was treated drug combined with rTMS. A and B groups were evaluated by using NRS,HAMD,MT and CSP before treatment, after treatment for 3 weeks and 6 weeks.Result:1.There is no statistical difference with PSPD patient bilateral cerebral hemisphere MT (P>0.05). In control group the right hemisphere MT is higher than the left hemisphere MT (P<0.05).Compared with PSPD patient group, the left hemisphere MT of control group is lower (P<0.05), the right hemisphere MT has no statistical difference (P>0.05). On the 3,6 weeks after the treatment, the right hemisphere MT of A group was lower than pre-treatment (P<0.05), the left hemisphere MT was higher than pre-treatment (P<0.05). Only on the 6 weeks after the treatment, the right hemisphere MT of B group was lower than pre-treatment (P< 0.05)2.On the 3,6 weeks after the treatment, the score of HAMD,NRS were all significant lower than the pre-treatment (P<0.001), and that A group, score of HAMD were significant lower than B group (P<0.05). On the 3 weeks after the treatment, A group NRS was lower than that of B group; but after the 6 weeks treatment, the NRS scores of the two groups had no significant difference (P>0.05)3 After 3 weeks of treatment, the right side CSP of A group patients was higher than pre-treatment, and the left side CSP of A group patients was lower than pre-treatment, but the difference was not statistically significant (P>0.05). On the 3 weeks after the treatment, the right CSP of A group patients was significant higher than that in the left. After 3 weeks of treatment,the two side CSP of B group patients was lower than pre-treatment (P>0.05),and there is no obvious difference between both sides of the CSP (P>0.05). After 6 weeks of treatment, the right cortical silent period of A group patients is still higher than the left (P> 0.05)Conclusion:1.The left motor cortex excitability in patients with PSPD is lower than that of normal control, and the hemispheric lateralization dysfunction may be an important impact of PSPD. But the deep relationship between human brain function asymmetry with PSPD remains to be further studied.2After the treatment with rTMS, the right side cortex inhibition of PSPD patients was relatively increased. This may be a compensatory for motor cortical excitability asymmetry being broken, and make the top-down connection function related cognitive control function recovery. Through improve patients cognitive function, to achieve the purpose of regulating pain.3.Both antidepressant medications and antidepressants combined with rTMS can alleviate PSPD patients' pain symptoms and unhealthy feelings. In terms of pain relief, pure antidepressants was slow than antidepressant combined with rTMS, Compared with antidepressant combined with rTMS, the antidepressant efficacy was poor and slowly. The two therapies may be synergistic effect, to improve the PSPD patients with depression and pain. |
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