重复经颅磁刺激对多发性硬化患者认知功能 及情绪的影响

Effects of Repetitive Transcranial Magnetic Stimulation on Cognitive Function and Emotion in Patients with Multiple Sclerosis

摘要: 目的：探讨高频重复经颅磁刺激(rTMS)对复发缓解型多发性硬化(RRMS)患者认知功能及情绪症状的影响。方法：纳入2024年7月至2025年11月就诊于内蒙古自治区人民医院的RRMS患者37例，均存在认知功能障碍，随机分为实验组(n = 15)和对照组(n = 22)。两组均维持原有疾病修正治疗，实验组加用20 Hz高频rTMS刺激左侧背外侧前额叶皮层(DLPFC)，每周5次，连续2周(共10次)。对照组不予特殊干预。于治疗前、治疗后3个月及6个月采用简易精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)评估认知功能，采用汉密尔顿抑郁量表(HAMD-17)、汉密尔顿焦虑量表(HAMA-14)评估情绪症状。结果：两组基线各量表评分无显著差异。干预后3个月和6个月，实验组MMSE、MoCA评分均显著高于对照组(P < 0.05)，HAMD、HAMA评分均极显著低于对照组(P < 0.001)。重复测量方差分析显示，各量表评分的组别 × 时间交互效应显著(P < 0.01)，提示rTMS干预效应独立于时间进程。实验组6个月时各评分较3个月略有回升，但仍显著优于基线及同期对照组，且MoCA评分始终维持正常阈值(>26分)。结论：高频rTMS刺激左侧DLPFC可显著改善RRMS患者的认知功能和情绪症状。

Abstract: Objective: To investigate the effects of high-frequency repetitive transcranial magnetic stimulation (rTMS) on cognitive function and emotional symptoms in patients with relapsing-remitting multiple sclerosis (RRMS). Methods: A total of 37 RRMS patients admitted to the Inner Mongolia Autonomous Region People’s Hospital from July 2024 to November 2025, all exhibiting cognitive dysfunction, were enrolled and randomly assigned to either the experimental group (n = 15) or the control group (n = 22). Both groups maintained their original disease-modifying therapy; the experimental group additionally received 20 Hz high-frequency rTMS stimulation to the left dorsolateral prefrontal cortex (DLPFC) five times per week for two consecutive weeks (totaling 10 sessions), while the control group received no special intervention. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) before treatment and at 3 and 6 months post-treatment, while emotional symptoms were evaluated using the Hamilton Depression Scale (HAMD-17) and Hamilton Anxiety Scale (HAMA-14). Results: No significant baseline differences were observed between the two groups on any of the scales. At 3 and 6 months post-intervention, the experimental group showed significantly higher MMSE and MoCA scores (P < 0.05) and markedly lower HAMD and HAMA scores (P < 0.001) compared to the control group. Repeated-measurement ANOVA revealed significant interaction effects of group × time on all scales (P < 0.01), indicating that the rTMS intervention effects were independent of time progression. At 6 months, the experimental group exhibited a slight improvement in all scores compared to 3 months, but remained significantly superior to both baseline and the control group at that time, with MoCA scores consistently maintaining normal thresholds (>26 points). Conclusion: High-frequency rTMS stimulation of the left DLPFC significantly improves cognitive function and emotional symptoms in RRMS patients.