iTBS刺激小脑蚓部改善小脑型多系统萎缩患者平衡功能的病例报告1例及文献复习

iTBS mode stimulation to cerebellar vermis improves balance function in patients with cerebellar-type multiple system atrophy: A case report and literature review

  • 摘要:
      背景   重复经颅磁刺激越来越多应用于多系统萎缩(multiple system atrophy,MSA)患者的治疗,其刺激参数和刺激模式是目前研究热点,间歇性Theta节律爆发式刺激(intermittent theta burst stimulation,iTBS)模式应用于改善MSA患者平衡功能的研究很少。
      目的   探索iTBS刺激小脑蚓部对小脑型多系统萎缩患者平衡功能的影响。
      方法   采用iTBS模式对患者小脑蚓部进行刺激。刺激强度为80% AMT,从内频率为50 Hz,从内数为3,从间频率为5 Hz,从间数为10,刺激时间为2 s,从间间隔为8 s,重复次数为20,单次脉冲数为600,一共刺激2次,中间间隔5 min休息,总脉冲数为1 200。1次/d,一共治疗10次。在治疗开始前、第1次治疗后即刻和第10次治疗后即刻采用近红外脑功能成像系统、Berg平衡量表、Fugl-Meyer平衡功能评定量表以及步态与平衡功能训练评估系统对患者的脑功能活动和平衡功能进行评估。
      结果   患者顶叶氧合血红蛋白激活程度经过治疗后双侧趋于平衡,左侧运动前区和左侧辅助运动区在执行平衡任务时氧合血红蛋白含量较治疗前增高。Berg 平衡量表得分从治疗前25分提升为39分;Fugl-Meyer平衡功能评定量表得分从治疗前10分提升至11分,步态各方面也有所改善。
      结论   iTBS刺激小脑蚓部可以为小脑型多系统萎缩患者改善平衡功能提供康复治疗优化方案的临床证据和参考思路。

     

    Abstract:
      Background   Repeated transcranial magnetic stimulation is increasingly used in patients with multiple system atrophy (MSA). Its stimulation parameters and stimulation mode are the focus of current research. There are few studies on the application of intermittent theta burst stimulation (iTBS) mode to improve the balance function for MSA patients.
      Objective   To explore the effect of iTBS stimulation on cerebellar vermis on balance function in patients with cerebellar-type MSA.
      Methods   The iTBS mode was used to stimulate the cerebellar vermis for patient. The stimulation intensity was 80% AMT, the internal frequency was 50 Hz, the internal number was 3, the interval frequency was 5 Hz, and the interval number was 10. The stimulation time was 2 seconds, with interval of 8 seconds, repetition number of 20 and single pulse number of 600, the total number of stimulations was 2 times with interval of 5 minutes, and the total number of pulses was 1 200, once a day for 10 times. The functional near-infrared spectroscopy system was used to detect and evaluate the brain function activity imaging of the patient, and the Berg Balance Scale, Fugl-Meyer Balance Assessment Scale and the Gait and Balance Training Assessment System were used to evaluate and analyze the patient's balance function before treatment, immediately after treatment, and on the tenth day.
      Results   The activation of oxygenated hemoglobin in the parietal lobe of the patient tended to be balanced on both sides, and the oxygenated hemoglobin content in the left premotor area and the left auxiliary motor area increased when performing the balance task after treatment. The score of Berg balance scale increased from 25 points before treatment to 39 points; The score of Fugl-Meyer balance function evaluation scale increased from 10 points before treatment to 11 points. Gait also improved in all aspects.
      Conclusion   iTBS mode stimulation of the cerebellar vermis can provide clinical evidence and reference idea for optimizing rehabilitation treatment to improve balance function for patients with cerebellar-type MSA.

     

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