高、低频重复经颅磁刺激治疗帕金森病患者临床功能障碍效果的Meta分析_《中国循证医学杂志》

作者：

王朴 ¹ ,  郭毅 ^2,3 , 廖维靖 ¹ , 李华钢 ⁴

1. 武汉大学中南医院康复医学科（武汉 430071）；2. 武汉大学公共卫生学院流行病学教研室（武汉 430071）； 3. 武汉大学病毒学国家重点实验室（武汉 430071）；4.武汉大学中南医院神经内科（武汉 430071）;

关键词：

重复经颅磁刺激功能障碍帕金森病 Meta分析系统评价

DOI：

10.7507/1672-2531.20100588

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价高、低频率重复经颅磁刺激治疗帕金森患者临床功能障碍的效果。
方法　计算机检索Cochrane图书馆（2010年第1期）、MEDLINE、EMbase、CBMdisc、CNKI中关于高、低频率重复经颅磁刺激对帕金森病（PD）患者临床功能障碍治疗的随机对照试验（RCT），同时筛检纳入文献的参考文献。文献检索起止时间均从建库至2010年4月。由2名研究者按纳入与排除标准选择文献、评价质量、提取资料并交叉核对，而后进行Meta分析。
结果　共纳入8个RCT。2个RCT的Meta分析结果显示，高频重复经颅磁刺激10天后PD患者的临床运动功能障碍的改善与对照组相比差异无统计学意义［WDM= – 4.75（– 13.73，4.23）］。3个RCT的Meta分析结果表明，低频重复经颅磁刺激治疗1月后对PD患者临床症状的改善与对照组相比差异无统计学意义［WDM= – 8.51（– 18.48，1.46）］。另外3个RCT的Meta分析结果表明，低频重复经颅磁刺激治疗3个月后PD患者临床功能障碍（神经、行为和情绪状态，临床运动功能，日常生活活动能力）的改善与对照组相比差异有统计学意义［WDM= – 5.79（– 8.44，– 1.13）］。在经颅磁刺激方案选择上，额部或运动皮质部的低频率（≤1Hz）、高强度（≥90% RMT）、多次数（≥3次）、长时间（≥3个月）的重复经颅磁刺激可能对PD患者临床功能障碍改善有积极影响，且具有远期效应。
结论　PD患者开展低频长期重复经颅磁刺激治疗可有效改善患者的临床症状和功能障碍。受纳入研究质量与数量限制，上述结果尚待更多高质量研究来证实。

引用本文： 王朴,郭毅,廖维靖,李华钢. 高、低频重复经颅磁刺激治疗帕金森病患者临床功能障碍效果的Meta分析. 中国循证医学杂志, 2010, 10(11): 1308-1315. doi: 10.7507/1672-2531.20100588 复制

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.	钟跃, 岛本宝哲, 重森稔. 重复经颅磁刺激治疗帕金森病. 现代神经疾病杂志, 2003, 3(4): 228-230.
26.	张鸿, 戴永萍, 苏敏, 等. 重复经颅磁刺激治疗帕金森病的临床研究. 临床神经病学杂志, 2005, 18(4): 266-269.
27.	王铭维, 顾平, 马晓伟, 等. 低频重复经颅磁刺激对帕金森病运动功能和情感障碍的疗效观察. 中华老年医学杂志, 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. 钟跃, 岛本宝哲, 重森稔. 重复经颅磁刺激治疗帕金森病. 现代神经疾病杂志, 2003, 3(4): 228-230.
26. 张鸿, 戴永萍, 苏敏, 等. 重复经颅磁刺激治疗帕金森病的临床研究. 临床神经病学杂志, 2005, 18(4): 266-269.
27. 王铭维, 顾平, 马晓伟, 等. 低频重复经颅磁刺激对帕金森病运动功能和情感障碍的疗效观察. 中华老年医学杂志, 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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《中国循证医学杂志》

高、低频重复经颅磁刺激治疗帕金森病患者临床功能障碍效果的Meta分析

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《中国循证医学杂志》

高、低频重复经颅磁刺激治疗帕金森病患者临床功能障碍效果的Meta分析

摘要 全文 图表 视频 参考文献 施引文献 补充材料

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