| Parkinson's disease is a neurodegenerative disease that is more common diagnosed in the elderly.Repetitive transcranial magnetic stimulation can be used as an adjuvant treatment for Parkinson's disease,however,the efficacy and mechanism of treatment are currently unclear.Objective: To investigate the efficacy of high-frequency repetitive transcranial magnetic stimulation on movement disorder in patients with Parkinson's disease,and to explore the mechanism of repetitive transcranial magnetic stimulation in the treatment of dyskinesia which will be determined by changes in resting state,measured via functional magnetic resonance imaging(fMRI).Methods: 31 patients with Parkinson's disease were enrolled in this study.They were divided into two groups: high-frequency stimulation group(5Hz-rTMS group),and sham stimulation group(sham-rTMS group).The two groups were matched in age,gender,and disease duration.The high-frequency stimulation group and the sham stimulation group were evaluated for motor function and fMRI data was collected before transcranial magnetic stimulation.The high-frequency stimulation group used 5 Hz of transcranial magnetic stimulation aimed at the patient's cortical M1 area every day for 12 days at 1200 pulses for 14 minutes,The sham stimulation group used shamstimulation to stimulate the patient's cortical M1 area every day for 12 days at 1200 pulses for 14 minutes,After the 12 days treatment,the motor function evaluation was repeated,and the resting state fMRI data was collected again.The effects of the highfrequency stimuli was observed by comparing the changes in motor function based on baseline and post-treatment evaluations,and the changes in the groups' fMRI images to examine the therapeutic and mechanism of effect.Results: 1.Motor function evaluation: The UPDRSIII score of the high-frequency stimulation group was significantly lower than that of the group pre-treatment,The 10-meter walking experiment and the 10-second pointing number test results also showed improvement.The motor function scores of the sham-stimulated group after treatment did not change significantly.Compared to the high-frequency stimulation group,patients in the sham-stimulated group improved in their UPDRSIII score and the 10-meter walking test,but the 10-second pointing number results did not measurably change;2.(1).In this study,5-Hz of stimulation increased the ReHo of the right caudate nucleus,while the ReHo of left cerebellum,the brainstem,and the right middle temporal gyrus were decreased;the sham-group had no significant changes.After comparison between the high-frequency stimulation group and the sham-stimulated group,the ReHo value of the right caudate nucleus increased more,and the ReHo of the left cerebellum decreased.(2).The right caudate nucleus was used as the ROI to calculate the functional connection between the right caudate nucleus and the whole brain.In the high-frequency stimulation group,we found that the functional connectivity of the right caudate nucleus and the right frontal pole,the right superior temporal gyrus and the right precuneus had increased compared to pre-stimulation results,There was no change in functional connectivity in sham stimulation group pre or post treatment.Functional connectivity increases between the right caudate nucleus and the right middle temporal gyrus,the thalamus,the right precuneus,and the bilateral prefrontal lobes were observed in the high frequency stimulation group whereas none of these changes were observed in the sham stimulation group.Conclusion: This study found that 5 Hz of transcranial magnetic stimulation can improve the motor function of patients with Parkinson disease,but there is no obvious effect on improving the control of fine motion(pointing).Based on the changes observed during resting state fMRI,high frequency stimulation enhances the functional connection between the basal ganglia(caudate nucleus),the thalamus,and the bilateral prefrontal lobes to improve motor function in Parkinson's patients. |
PDF Full Text Request