高、低頻重復經顱磁刺激治療帕金森病患者臨床功能障礙效果的Meta分析_《中國循證醫學雜志》

作者：

王樸 ¹ ,  郭毅 ^2,3 , 廖維靖 ¹ , 李華鋼 ⁴

1. 武漢大學中南醫院康復醫學科（武漢 430071）；2. 武漢大學公共衛生學院流行病學教研室（武漢 430071）； 3. 武漢大學病毒學國家重點實驗室（武漢 430071）；4.武漢大學中南醫院神經內科（武漢 430071）;

關鍵詞：

重復經顱磁刺激功能障礙帕金森病 Meta分析系統評價

DOI：

10.7507/1672-2531.20100588

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目的　系統評價高、低頻率重復經顱磁刺激治療帕金森患者臨床功能障礙的效果。
方法　計算機檢索Cochrane圖書館（2010年第1期）、MEDLINE、EMbase、CBMdisc、CNKI中關于高、低頻率重復經顱磁刺激對帕金森病（PD）患者臨床功能障礙治療的隨機對照試驗（RCT），同時篩檢納入文獻的參考文獻。文獻檢索起止時間均從建庫至2010年4月。由2名研究者按納入與排除標準選擇文獻、評價質量、提取資料并交叉核對，而后進行Meta分析。
結果　共納入8個RCT。2個RCT的Meta分析結果顯示，高頻重復經顱磁刺激10天后PD患者的臨床運動功能障礙的改善與對照組相比差異無統計學意義［WDM= –?4.75（–?13.73，4.23）］。3個RCT的Meta分析結果表明，低頻重復經顱磁刺激治療1月后對PD患者臨床癥狀的改善與對照組相比差異無統計學意義［WDM= –?8.51（–?18.48，1.46）］。另外3個RCT的Meta分析結果表明，低頻重復經顱磁刺激治療3個月后PD患者臨床功能障礙（神經、行為和情緒狀態，臨床運動功能，日常生活活動能力）的改善與對照組相比差異有統計學意義［WDM= –?5.79（–?8.44，–?1.13）］。在經顱磁刺激方案選擇上，額部或運動皮質部的低頻率（≤1Hz）、高強度（≥90% RMT）、多次數（≥3次）、長時間（≥3個月）的重復經顱磁刺激可能對PD患者臨床功能障礙改善有積極影響，且具有遠期效應。
結論　PD患者開展低頻長期重復經顱磁刺激治療可有效改善患者的臨床癥狀和功能障礙。受納入研究質量與數量限制，上述結果尚待更多高質量研究來證實。

引用本文： 王樸,郭毅,廖維靖,李華鋼. 高、低頻重復經顱磁刺激治療帕金森病患者臨床功能障礙效果的Meta分析. 中國循證醫學雜志, 2010, 10(11): 1308-1315. doi: 10.7507/1672-2531.20100588 復制

1.	Liu LX, Chen WF, Xie JX, et al. Neuroprotective effects of genistein on dopaminergic neurons in the mice model of Parkinson’s disease. Neurosci Res, 2008, 60(2):156-161.
2.	Faherty CJ, Raviie Shepherd K, Herasimtschuk A, et al. Environmental enrichment in adulthood eliminates neuronal death in experimental Parkinsonism. Brain Res Mol Brain Res, 2005, 134(1): 170-179.
3.	Fahn S, Oakes D, Shoulson I, et al. Levodopa and the progression of Parkinson’s disease. N Engl J Med, 2004, 351(24): 2498-2508.
4.	Stocchi F. The therapeutic concept of continuous dopaminergic stimulation (CDS) in the treatment of Parkinson’s disease. Parkinsonism Relat Disord, 2009, 15(3): 68-71.
5.	Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulotion of human motor cortex . Lancet, 1985, 1(8437): 1106-1107.
6.	Rothwell JC. Techniques and mechanisms of action of transcranial stimulation of a human motor cortex. J Neurosci Methods, 1997, 74(2): 113-122.
7.	Paseual-Leone A, Valls-Solé J, Brasil-Neto JP, et al. Akinesia in Parkinson’s disease.Ⅱ.Effects of subthreshold repetitive transcranial motor cortex stimulation. Neurology, 1994, 44(5): 892-898.
8.	Cantello R, Tarletti R, Civardi C. Transcranial magnetic stimulation and Parkinson’s disease. Brain Research Reviews, 2002, 38(3): 309-327.
9.	Cunnington R, Iansek R,Thickbroom GW, et al. Effects of magnetic stimulation over supplementary motor area on movement in Parkinson’s disease. Brain, 1996, 119(3): 815-822.
10.	Diószeghy P, Hidasi E, Mechler F. Study of central motor functions using magnetic stimulation in Parkinson’s disease. Electromyogr Clin Neurophysiol, 1999, 12(39): 101-105.
11.	Rektorova I, Sedlackova S. Telecka A, et al. Dorsolateral Prefrontal Cortex: A Possible Target for Modulating Dyskinesias in Parkinson’s Disease by Repetitive Transcranial Magnetic Stimulation. Int J Biomed Imaging, 2008 (10): 1155-1161.
12.	Boylan LS, Pullman SL, Lisanby SH, et al. Repetitive transcranial magnetic stimulation to SMA worsens complex movement in Parkinsion’s disease. Clin Neurophysiol, 2001, 112(2): 259-264.
13.	Okabe S, Ugawa Y, Kanazawa I. 0.2-Hz rTMS has no add-on effects as compared to a realistic sham stimulation in Parkinson’s disease. Mov Disord, 2003, 18(4): 382-388.
14.	Ghabra MB, Hallett M, Wassemann EM. Simultaneous repetitive transcranial magnetic stimulation does not speed fine movement in PD. Neurology, 1999, 52: 768-770.
15.	Tergau F, Wassemann EM, Paulus W, et al. Lack of clinical improvement in patients with Parkinsen’s disease after low and high frequency transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol Suppl, 1999, 51: 281-288.
16.	Goetz CG, Wu J, Michael P, et al. Placebo respones in Parkinson’s disease: Comparisons among 11 trails covering medical and surgical interventions. Mov Disord, 2008, 23(5): 690-699.
17.	Del Olmo MF, Bello O, Cuderio J. Transcranial magnetic stimulation over dorsolateral preforntal cortex in Parkinson’s disease. Clin Neurophysiol, 2007, 118(1): 131-139.
18.	Mally J, Stone TW. Therapeutic and "dose dependent" effect of repetitive microelectroshock induced by transcranial magnetic stimulation in Parkinson’s disease. J Neurosci Res, 1999, 57(6): 935-940.
19.	Siebner HR, Rossmeier C, Mentschel C, et al. Short-term motor improvement after sub-threshold 5-Hz repetitive transcranial magnetic stimulation of the primary motor hand area in Parkinson’s disease. J Neurol Sci, 2000, 178(2): 91-94.
20.	Edelmuth RC, Nitsche MA, Battistella L, et al. Why do some promising brain-stimulation devices fail the next steps of clinical development. Expert Rev Med Devices, 2010, 7(1): 67-97.
21.	Higgins JPT, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6 2006: The Cochrane Collaboration.
22.	Shimamoto H, Takasaki K, Shigemori M, et al. Therapeutic effect and mechanism of repetitive transcranial magnetic stimulation in Parkinson’s disease. J Neurol, 2001, 248(Suppl 3): 48-52.
23.	Khedr EM, Farweez HM Islam H. Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson’s disease patients. Eur J Neurol, 2003, 10(5): 567-572.
24.	Lomarev MP, Wu J, Michael P, et al. Placebo-Controlled Study of rTMS for the Treatment of Parkinson’s Disease. Mov Disord, 2006, 21(3):325-331.
25.	鐘躍, 島本寶哲, 重森稔. 重復經顱磁刺激治療帕金森病. 現代神經疾病雜志, 2003, 3(4): 228-230.
26.	張鴻, 戴永萍, 蘇敏, 等. 重復經顱磁刺激治療帕金森病的臨床研究. 臨床神經病學雜志, 2005, 18(4): 266-269.
27.	王銘維, 顧平, 馬曉偉, 等. 低頻重復經顱磁刺激對帕金森病運動功能和情感障礙的療效觀察. 中華老年醫學雜志, 2009, 28(9): 729-732.
28.	Gorsler A, Bäumer T, Weiller C, et al. Interhemispheric effects of high and low frequency rTMS in healthy humans. Clin Neurophysiol, 2003, 114(10): 1800-1807.
29.	Gangitano M, Valero-Cabré A, Tormos JM, et al. Modulation of input–output curves by low and high frequency repetitive transcranial magnetic stimulation of the motor cortex. Clin Neurophysiol, 2002, 113(8): 1249-1257.
30.	Paul B, Fountain FS, Zafiris J, et al. Comprehensive review of the effects of rTMS on motor cortical excitability and inhibition. Clin Neurophysiol, 2006, 117(12): 2584-2596.
31.	Valero-Cabré A, Payne BR, Pascual-Leone A. Opposite impact on 14C-2-deoxyglucose brain metabolism following patterns of high and low frequency repetitive transcranial magnetic stimulation in the posterior parietal cortex. Exp Brain Res, 2007, 176(4): 603-615.
32.	Wassermann EM, Lisanby SH. Therapeutic application of repetitive transeranial magnetic stimulation: a review. Clin Neurophysiol, 2001, 112(8): 1367-1377.
33.	Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry, 2003, 160(5): 835-845.
34.	Helmieh RC, Siebner HR, Bakker M, et al. Repetitive transcranial magnetic stimulation to improve mood and motor function in Parkinson’s disease. J Neurol Sci, 2006, 248(2): 84-96.
35.	Edwards MJ, Talelli P, Rothwell JC. Clinical applications of transcranial magnetic stimulation in patients with movement disorders. Lancet Neurol, 2008, 7(9): 827-840.
36.	Bornke Ch, Schulte T, Przuntek H, et al. Clinical effects of repetitive transcranial magnetic stimulation venus acute levodopa challenge in Parkinson’s disease. Neural Transm Suppl, 2004, 68(7): 61-67.
37.	Lefaucheur JP, Drouot X, Yon Raison F, et al. Improvement of motor performance and modulation of conical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson’s disease. Clin Neurophysiol, 2004, 15(6): 2530-2541.
38.	Shimamoto H, Morimitsu H, Sugita S, et al. Therapeutic effect of repetitive transcranial magnetic stimulation in Parkinson’s disease. J Neurol, 1999, 39 (2): 1264-1267.

1. Liu LX, Chen WF, Xie JX, et al. Neuroprotective effects of genistein on dopaminergic neurons in the mice model of Parkinson’s disease. Neurosci Res, 2008, 60(2):156-161.
2. Faherty CJ, Raviie Shepherd K, Herasimtschuk A, et al. Environmental enrichment in adulthood eliminates neuronal death in experimental Parkinsonism. Brain Res Mol Brain Res, 2005, 134(1): 170-179.
3. Fahn S, Oakes D, Shoulson I, et al. Levodopa and the progression of Parkinson’s disease. N Engl J Med, 2004, 351(24): 2498-2508.
4. Stocchi F. The therapeutic concept of continuous dopaminergic stimulation (CDS) in the treatment of Parkinson’s disease. Parkinsonism Relat Disord, 2009, 15(3): 68-71.
5. Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulotion of human motor cortex . Lancet, 1985, 1(8437): 1106-1107.
6. Rothwell JC. Techniques and mechanisms of action of transcranial stimulation of a human motor cortex. J Neurosci Methods, 1997, 74(2): 113-122.
7. Paseual-Leone A, Valls-Solé J, Brasil-Neto JP, et al. Akinesia in Parkinson’s disease.Ⅱ.Effects of subthreshold repetitive transcranial motor cortex stimulation. Neurology, 1994, 44(5): 892-898.
8. Cantello R, Tarletti R, Civardi C. Transcranial magnetic stimulation and Parkinson’s disease. Brain Research Reviews, 2002, 38(3): 309-327.
9. Cunnington R, Iansek R,Thickbroom GW, et al. Effects of magnetic stimulation over supplementary motor area on movement in Parkinson’s disease. Brain, 1996, 119(3): 815-822.
10. Diószeghy P, Hidasi E, Mechler F. Study of central motor functions using magnetic stimulation in Parkinson’s disease. Electromyogr Clin Neurophysiol, 1999, 12(39): 101-105.
11. Rektorova I, Sedlackova S. Telecka A, et al. Dorsolateral Prefrontal Cortex: A Possible Target for Modulating Dyskinesias in Parkinson’s Disease by Repetitive Transcranial Magnetic Stimulation. Int J Biomed Imaging, 2008 (10): 1155-1161.
12. Boylan LS, Pullman SL, Lisanby SH, et al. Repetitive transcranial magnetic stimulation to SMA worsens complex movement in Parkinsion’s disease. Clin Neurophysiol, 2001, 112(2): 259-264.
13. Okabe S, Ugawa Y, Kanazawa I. 0.2-Hz rTMS has no add-on effects as compared to a realistic sham stimulation in Parkinson’s disease. Mov Disord, 2003, 18(4): 382-388.
14. Ghabra MB, Hallett M, Wassemann EM. Simultaneous repetitive transcranial magnetic stimulation does not speed fine movement in PD. Neurology, 1999, 52: 768-770.
15. Tergau F, Wassemann EM, Paulus W, et al. Lack of clinical improvement in patients with Parkinsen’s disease after low and high frequency transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol Suppl, 1999, 51: 281-288.
16. Goetz CG, Wu J, Michael P, et al. Placebo respones in Parkinson’s disease: Comparisons among 11 trails covering medical and surgical interventions. Mov Disord, 2008, 23(5): 690-699.
17. Del Olmo MF, Bello O, Cuderio J. Transcranial magnetic stimulation over dorsolateral preforntal cortex in Parkinson’s disease. Clin Neurophysiol, 2007, 118(1): 131-139.
18. Mally J, Stone TW. Therapeutic and "dose dependent" effect of repetitive microelectroshock induced by transcranial magnetic stimulation in Parkinson’s disease. J Neurosci Res, 1999, 57(6): 935-940.
19. Siebner HR, Rossmeier C, Mentschel C, et al. Short-term motor improvement after sub-threshold 5-Hz repetitive transcranial magnetic stimulation of the primary motor hand area in Parkinson’s disease. J Neurol Sci, 2000, 178(2): 91-94.
20. Edelmuth RC, Nitsche MA, Battistella L, et al. Why do some promising brain-stimulation devices fail the next steps of clinical development. Expert Rev Med Devices, 2010, 7(1): 67-97.
21. Higgins JPT, Green S. Cochrance Handbook for Systematic Reviews of Interventions 4.2.6 2006: The Cochrane Collaboration.
22. Shimamoto H, Takasaki K, Shigemori M, et al. Therapeutic effect and mechanism of repetitive transcranial magnetic stimulation in Parkinson’s disease. J Neurol, 2001, 248(Suppl 3): 48-52.
23. Khedr EM, Farweez HM Islam H. Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson’s disease patients. Eur J Neurol, 2003, 10(5): 567-572.
24. Lomarev MP, Wu J, Michael P, et al. Placebo-Controlled Study of rTMS for the Treatment of Parkinson’s Disease. Mov Disord, 2006, 21(3):325-331.
25. 鐘躍, 島本寶哲, 重森稔. 重復經顱磁刺激治療帕金森病. 現代神經疾病雜志, 2003, 3(4): 228-230.
26. 張鴻, 戴永萍, 蘇敏, 等. 重復經顱磁刺激治療帕金森病的臨床研究. 臨床神經病學雜志, 2005, 18(4): 266-269.
27. 王銘維, 顧平, 馬曉偉, 等. 低頻重復經顱磁刺激對帕金森病運動功能和情感障礙的療效觀察. 中華老年醫學雜志, 2009, 28(9): 729-732.
28. Gorsler A, Bäumer T, Weiller C, et al. Interhemispheric effects of high and low frequency rTMS in healthy humans. Clin Neurophysiol, 2003, 114(10): 1800-1807.
29. Gangitano M, Valero-Cabré A, Tormos JM, et al. Modulation of input–output curves by low and high frequency repetitive transcranial magnetic stimulation of the motor cortex. Clin Neurophysiol, 2002, 113(8): 1249-1257.
30. Paul B, Fountain FS, Zafiris J, et al. Comprehensive review of the effects of rTMS on motor cortical excitability and inhibition. Clin Neurophysiol, 2006, 117(12): 2584-2596.
31. Valero-Cabré A, Payne BR, Pascual-Leone A. Opposite impact on 14C-2-deoxyglucose brain metabolism following patterns of high and low frequency repetitive transcranial magnetic stimulation in the posterior parietal cortex. Exp Brain Res, 2007, 176(4): 603-615.
32. Wassermann EM, Lisanby SH. Therapeutic application of repetitive transeranial magnetic stimulation: a review. Clin Neurophysiol, 2001, 112(8): 1367-1377.
33. Gershon AA, Dannon PN, Grunhaus L. Transcranial magnetic stimulation in the treatment of depression. Am J Psychiatry, 2003, 160(5): 835-845.
34. Helmieh RC, Siebner HR, Bakker M, et al. Repetitive transcranial magnetic stimulation to improve mood and motor function in Parkinson’s disease. J Neurol Sci, 2006, 248(2): 84-96.
35. Edwards MJ, Talelli P, Rothwell JC. Clinical applications of transcranial magnetic stimulation in patients with movement disorders. Lancet Neurol, 2008, 7(9): 827-840.
36. Bornke Ch, Schulte T, Przuntek H, et al. Clinical effects of repetitive transcranial magnetic stimulation venus acute levodopa challenge in Parkinson’s disease. Neural Transm Suppl, 2004, 68(7): 61-67.
37. Lefaucheur JP, Drouot X, Yon Raison F, et al. Improvement of motor performance and modulation of conical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson’s disease. Clin Neurophysiol, 2004, 15(6): 2530-2541.
38. Shimamoto H, Morimitsu H, Sugita S, et al. Therapeutic effect of repetitive transcranial magnetic stimulation in Parkinson’s disease. J Neurol, 1999, 39 (2): 1264-1267.

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高、低頻重復經顱磁刺激治療帕金森病患者臨床功能障礙效果的Meta分析

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《中國循證醫學雜志》

高、低頻重復經顱磁刺激治療帕金森病患者臨床功能障礙效果的Meta分析

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