重复经颅磁刺激联合常规药物治疗对血管性帕金森综合征运动症状的影响

Effects of repetitive transcranial magnetic stimulation combined with conventional pharmacotherapy on motor symptoms of vascular parkinsonism

摘要

背景 血管性帕金森综合征由脑血管病变所致,可造成患者运动能力下降、生活质量降低。重复经颅磁刺激(rTMS)作为无创神经调控手段,在多种神经系统疾病中展现出应用潜力,但其对血管性帕金森综合征的治疗效果仍需进一步验证。目的 探讨rTMS联合常规药物对血管性帕金森综合征患者运动功能的改善作用及临床安全性。方法 选取2023年1月-2025年10月在山东省戴庄医院神经内科收治的60例确诊患者,随机分为常规组与联合组。常规组仅给予左旋多巴治疗,联合组在左旋多巴基础上加用rTMS干预。干预2周后,比较治疗前后采用MDS-UPDRS-Ⅲ量表、PDADL量表评估患者运动功能及日常生活能力。结果 联合组干预2周后运动功能及日常活动能力评分较治疗前均有不同程度的下降。治疗前后联合组的MDS-UPDRS-Ⅲ量表、PDADL量表得分差值(1.93±1.48)分、(2.70±0.46)分,均大于常规组(0.67±1.18)分、(2.33±0.66)分,差异具有统计学意义(t=3.65,t=2.48,P<0.05)。两组不良事件发生率相近(P>0.05),且未出现严重不良反应。结论 在常规药物治疗基础上联合rTMS,短期可显著改善血管性帕金森综合征患者近期的运动症状,整体安全性良好,具备一定的临床推广价值。

Abstract

Background Vascular parkinsonism results from cerebrovascular lesions,which can lead to impair motor function and reduced quality of life in patients.Repetitive transcranial magnetic stimulation (rTMS),as a non-invasive neuromodulation technique,has shown potential for application in various neurological disorders;however,its therapeutic effect on vascular parkinsonism requires further validation. Objective To investigate the efficacy of rTMS combined with conventional medication on motor function in patients with vascular parkinsonism and its clinical safety. Methods Sixty patients with a confirmed diagnosis of vascular parkinsonism (VP) were randomly divided into two groups:a combination group and a control group.The control group received levodopa as a single therapeutic agent,while the combination group was treated with levodopa combined with repetitive transcranial magnetic stimulation (rTMS).Motor function and daily living ability were evaluated by MDS-UPDRS-Ⅲ and PDADL scales before and after treatment. Results After 2 weeks of intervention,both motor function and activities of daily living (ADL) scores in the combined group showed a certain degree of decline relative to baseline.Analysis of the net score improvements showed that the combined group exhibited larger reductions in the MDS-UPDRS-Ⅲ scale (1.93±1.48 points) and PDADL scale (2.7±0.46 points).These decreases were significantly greater than those observed in the conventional group (0.67±1.18 points and 2.33±0.66 points,respectively),with statistically significant intergroup differences (t=3.65,t=2.48,P<0.05).No serious adverse events were reported in either group throughout the study period. Conclusion In addition to conventional pharmacotherapy,combined with rTMS,it can significantly improve the motor symptoms of patients with vascular Parkinsonism in the short term.The overall safety is good and it possesses promising prospects for clinical application.

关键词

血管性帕金森综合征 / 重复经颅磁刺激 / 运动功能 / 左旋多巴 / 联合治疗

Key words

Vascular parkinsonism / Repetitive transcranial magnetic stimulation / Motor function / Levodopa / Combination therapy

参考文献

[1] 李涛, 侯媛媛, 王豆, 等 . 血管性帕金森综合征的病因、病理、诊断及治疗研究进展[J]. 医学综述, 2018, 24(23): 4710-4715.DOI: 10.3969/j.issn.1006-2084.2018.23.026.

[2] 中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组 . 中国帕金森病治疗指南(第四版)[J]. 中华神经科杂志, 2020, 53(12): 973-986.DOI: 10.3760/cma.j.cn113694-20200331-00233.

[3] 中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍专业委员会 . 中国血管性帕金森综合征诊断与治疗专家共识[J]. 全科医学临床与教育, 2017, 15(4): 364-367.DOI: 10.13558/j.cnki.issn1672-3686.2017.04.002.

[4] Chung CL, Mak MK, Hallett M . Transcranial magnetic stimulation promotes gait training in parkinson disease[J]. Ann Neurol, 2020, 88(5): 933-945.DOI: 10.1002/ana.25881.

[5] 吴少璞, 李学, 祁亚伟, 等 . 重复经颅磁刺激联合康复训练改善帕金森病运动及非运动症状的疗效观察[J]. 中华物理医学与康复杂志, 2019, 41(5): 338-343.DOI: 10.3760/cma.j.issn.0254-1424.2019.05.006.

[6] 帕提曼·吾斯曼, 王宝兰, 库尔班乃木·卡合曼, 等 . 加速小脑间歇性θ爆发式磁刺激联合运动疗法对亚急性期脑卒中患者的影响[J]. 康复学报, 2026, 36(2): 105-112.DOI: 10.3724/SP.J.1329.2026.02005.

[7] 张俊霞, 徐沙丽, 金俏, 等 . 重复经颅磁刺激联合药物治疗对血管性帕金森综合征患者运动功能的影响[J]. 中华物理医学与康复杂志, 2021, 43(10): 930-932.DOI: 10.3760/cma.j.issn.0254-1424.2021.10.016.

[8] Yun SJ, Lee HS, Kim DH, et al. Efficacy of personalized repetitive transcranial magnetic stimulation based on functional reserve to enhance ambulatory function in patients with Parkinson′s disease:study protocol for a randomized controlled trial[J]. Trials, 2024, 25(1): 543.DOI: 10.1186/s13063-024-08385-2.

[9] Asadizeidabadi A, Hosseini S, Pyatkov A . Effects of repetitive transcranial magnetic stimulation on tumor necrosis factor alpha in neuropsychological disorders:a systematic review and meta-analysis[J]. Brain Behav, 2025, 15(2): e70329.DOI: 10.1002/brb3.70329.

[10] Lu W, Yan L, Li C, et al. Efficacy and safety of repetitive transcranial magnetic stimulation on motor function,depression,and cognitive dysfunction in Parkinson′s disease:a systematic review and meta-analysis of randomized controlled trials[J]. Clin Park Relat Disord, 2026, 14: 100422.DOI: 10.1016/j.prdoa.2026.100422.

[11] 徐丽丽 . 重复经颅磁刺激治疗对血管性帕金森综合征患者步态及平衡功能影响的临床研究[D]. 兰州: 甘肃中医药大学, 2021.

[12] 谈世东, 强朝晖 . 血管性帕金森综合征和帕金森病颈动脉彩色超声及经颅多普勒检查临床分析[J]. 中国实用神经疾病杂志, 2020, 23(5): 411-415.DOI: 10.12083/SYSJ.2020.05.201.

基金资助

济宁市重点研发计划项目(2023YXNS209)