不同频率重复经颅磁刺激在儿童抽动障碍中的疗效评价
Efficacy Evaluation of Repetitive Transcranial Magnetic Stimulation with Different Frequencies in Children with Tic Disorders
DOI: 10.12677/ACM.2022.12121579, PDF,   
作者: 李查干呼, 图 雅*：内蒙古自治区妇幼保健院儿内科，内蒙古 呼和浩特
关键词: 儿童；抽动障碍；不同频率；重复经颅磁刺激；Children； Tic Disorders； Different Frequency； Repetitive Transcranial Magnetic Stimulation
摘要: 目的：探讨不同频率重复经颅磁刺激(rTMS)治疗抽动障碍(TD)患儿的临床疗效。方法：共选取40例确诊TD患儿，随机分为高频率组20例和低频率组20例。采用rTMS刺激于TD患儿大脑左、右额极区(FP1, FP2)，刺激频率为高频组15 Hz，低频组1 Hz，脉冲数均为90脉冲/次，3次/天，每次脉冲间隔15 s，刺激强度为45%静息阈值(RMT)，连续治疗8天，停2天为一个疗程，持续治疗三个疗程(一个月)。在治疗前、治疗1月和治疗后6个月，两组患儿的病情严重程度用YGTSS量表评估；治疗1月和治疗后6月组临床疗效采用CGI-ei评价。并记录不良反应。结果：治疗前，高频率组与低频率组患儿相比，YGTSS评分差异无统计学意义(P > 0.05)；治疗1月组及治疗后6月组：YGTSS评分高频组均低于低频组，差异有统计学意义(P < 0.01)；CGI-ei评分高频组均高于低频组，且差异有统计学意义(P < 0.01)。两组临床症状均明显改善。结论：1) 高频率组(15 Hz)与低频率组(1 Hz)，治疗1个月结果显示对患儿临床抽动症状(包括抽动形式、次数、强度、频率)均有明显改善；YGTSS评分和CGI-ei评分均显示rTMS治疗TD患儿有良好效果。2) 治疗1月及治疗后6月组的两种评分显示，rTMS的高频刺激较低频刺激治疗效果更加明显。3) 两组患儿在治疗及随访中均未见明显不良反应。
Abstract: Objective: To investigate the clinical efficacy of different frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of tic disorder (TD) in children. Methods: A total of 40 children diagnosed with TD were selected and randomly divided into high frequency group (20 cases) and low frequency group (20 cases). rTMS was used to stimulate the left and right frontal polar regions (FP1, FP2) of the brain of the children with TD. The stimulation frequency was 15 Hz in the high frequency group and 1 Hz in the low frequency group. The pulse number was 90 pulses per time, 3 times per day, the interval of each pulse was 15 s, and the stimulation intensity was 45% resting threshold (RMT), continuous treatment for 8 days, stopping for 2 days as a course of treatment, and continuous treatment for three courses (one month). YGTSS scale was used to evaluate the severity of the disease in the two groups before treatment, 1 month and 6 months after treatment. The clin-ical efficacy of 1 month and 6 months after treatment was evaluated by CGI-ei. Adverse reactions were recorded. Results: Before treatment, there was no significant difference in YGTSS scores be-tween the high frequency group and the low frequency group (P > 0.05); 1 month treatment group and 6 months after treatment group: YGTSS score in the high frequency group was lower than that in the low frequency group, and the difference was statistically significant (P < 0.01). CGI-ei scores in high frequency group were higher than those in low frequency group, and the difference was statis-tically significant (P < 0.01). The clinical symptoms of both groups were significantly improved. Con-clusions: 1) The frequency 15 Hz (high frequency) or 1 Hz (low frequency) group treated for 1 month, showed that the clinical tic symptoms (including tic form, frequency, intensity, frequency) in children have improved significantly, YGTSS scores and CGI-ei scores showed that rTMS treatment of TD children is effective. 2) The two scores of treatment 1 month of treatment and 6 months after treatment showed that rTMS treatment with high frequency stimulation is more effective for lower frequency stimulation and the improvement of clinical symptoms was more prominent. 3) No sig-nificant adverse reactions were seen in the two groups during treatment and follow-up.
文章引用：李查干呼, 图雅. 不同频率重复经颅磁刺激在儿童抽动障碍中的疗效评价[J]. 临床医学进展, 2022, 12(12): 10965-10972. https://doi.org/10.12677/ACM.2022.12121579

参考文献

[1] 卢青, 崔永华, 刘智胜, 等. 新诊断儿童抽动障碍及其共患病单药治疗调查分析[J]. 中华儿科杂志, 2020, 58(11): 887-892.
[2] 乔虹. 非典型抗精神病药物的副作用[J]. 国外医学(药学分册), 2005, 32(1): 26-28.
[3] 杨斌, 张兰, 刘建斌. 抗精神病药物引起的体质量增加与瘦素的关系[J]. 中国临床康复, 2004, 8(36): 8332-8333.
[4] 李天森, 李经雷. 氟哌啶醇致麻醉后锥体外系反应5例分析[J]. 中国误诊学杂志, 2006, 6(18): 3621-3622.
[5] 卢青, 孙丹, 刘智胜. 中国抽动障碍诊断和治疗专家共识解读[J]. 中华实用儿科临床杂志, 2021, 36(9): 647-653.
[6] Ho, C.S., Huang, J.Y., Yang, C.H., et al. (2020) Is the Yale Global Tic Severity Scale a Valid Tool for Parent-Reported Assess-ment in the Paediatric Population? A Prospective Observational Study in Taiwan. BMJ Open, 10, e034634. [Google Scholar] [CrossRef] [PubMed]
[7] McGuire, J.F., Piacentini, J., Storch, E.A., et al. (2021) Defin-ing Tic Severity and Tic Impairment in Tourette Disorder. Journal of Psychiatric Research, 133, 93-100. [Google Scholar] [CrossRef] [PubMed]
[8] 翟倩, 丰雷, 张国富. 儿童抽动障碍病因及治疗进展[J] .中国实用儿科杂志, 2020, 35(1): 66-72.
[9] 陈洁. 重复经颅磁刺激治疗儿童多发性抽动症疗效观[J]. 医药前沿察, 2014, 2(2): 122-123.
[10] Lefaucheur, J.P. (2019) Transcranial Magnetic Stimulation. Handbook of Clinical Neu-rology, 160, 559-580. [Google Scholar] [CrossRef] 
[11] 刘耀中, 张臖, 窦凯, 等. 重复经颅磁刺激治疗强迫症的研究进展[J]. 暨南大学学报(自然科学与医学版), 2014(2): 136-141.
[12] 余锋, 赵合庆, 孙永安. 经颅磁刺激对脑缺血-再灌注大鼠急性期脑内单胺类神经递质含量的影响[J]. 中国脑血管病杂志, 2007, 4(2): 76-80.
[13] Zhang, C., Lu, R., Wang, L., Yun, W. and Zhou, X. (2019) Restraint Devices for Repetitive Transcranial Magnetic Stimulation in Mice and Rats. Brain and Behavior, 9, e01305. [Google Scholar] [CrossRef] [PubMed]
[14] Kwon, H.J., Lim, W.S., Lim, M.H., et al. (2011) 1-Hz Low Frequency Re-petitive Transcranial Magnetic Stimulation in Children with Tourette’s Syndrome. Neuroscience Letters, 492, 1-4. [Google Scholar] [CrossRef] [PubMed]
[15] Kahl, C.K., Kirton, A., Pringsheim, T., et al. (2021) Bilateral Transcranial Magnetic Stimulation of the Supplementary Motor Area in Children with Tourette Syndrome. Developmen-tal Medicine & Child Neurology, 63, 808-815. [Google Scholar] [CrossRef] [PubMed]
[16] Spagnolo, P.A. and Goldman, D. (2017) Neuromodulation Interven-tions for Addictive Disorders: Challenges, Promise, and Roadmap for Future Research. Brain, 140, 1183-1203. [Google Scholar] [CrossRef] [PubMed]
[17] Mix, A., Benali, A., Eysel, U.T. and Funke, K. (2010) Continuous and Intermittent Transcranial Magnetic Theta Burst Stimulation Modify Tactile Learning Performance and Cortical Protein Expression in the Rat Differently. European Journal of Neuroscience, 32, 1575-1586. [Google Scholar] [CrossRef] [PubMed]
[18] Jung, S.H., Shin, J.E., Jeong, Y.S. and Shin, H.I. (2008) Changes in Motor Cortical Excitability Induced by High-Frequency Repetitive Transcranial Magnetic Stimulation of Dif-ferent Stimulation Durations. Clinical Neurophysiology, 119, 71-79. [Google Scholar] [CrossRef] [PubMed]
[19] Ahn, S. and Hwang, S. (2019) Virtual Rehabilitation of Upper Extremity Function and Independence for Stoke: A Meta-Analysis. Journal of Exercise Rehabilitation, 15, 358-369. [Google Scholar] [CrossRef] 
[20] 陈敏. 重复经颅磁刺激治疗儿童抽动障碍疗效探讨[D]: [硕士学位论文]. 呼和浩特: 内蒙古医科大学, 2015: 1-36.
[21] 孙静. 低频与高频重复经颅磁刺激治疗小儿抽动症的疗效观察[J]. 中国医药指南, 2021, 21(19): 38-39.
[22] Boggio, P.S., Rocha, M., Oliveira, M.O., et al. (2010) Nonin-vasive Brain Stimulation with High-Frequency and Low-Intensity Repetitive Transcranial Magnetic Stimulation Treat-ment for Posttraumatic Stress Disorder. The Journal of Clinical Psychiatry, 71, 992-999. [Google Scholar] [CrossRef] 
[23] Ossi, S., Bartalini, S., Ulivelli, M., et al. (2005) Hypofunctioning of Sensory Gating Mechanisms in Patients with Obsessive-Compulsive Disorder. Biological Psychiatry, 57, 16-20． [Google Scholar] [CrossRef] [PubMed]
[24] Rossi, S., Hallett, M., Rossini, P.M., et al. (2009) Safety, Ethical Considerations and Application Guidelines for the Use of Transcranial Magnetic Stimulation in Clinical Practice and Research. Clinical Neurophysiology, 120, 2008-2039. [Google Scholar] [CrossRef] [PubMed]

为你推荐