【摘要】：目的： 研究1Hz低頻重復(fù)經(jīng)顱磁刺激(repetitive transcranial magneticstimulation，rTMs)作用于輔助運動區(qū)（supplemental motor area，SMA）對多發(fā)性抽動癥(Tourette syndrome，TS)患兒治療效果，并隨訪6個月觀察。 方法： 1.收集25例確診TS患兒，年齡7.2-15.4歲之間，男22例，女3例，病程1-6.5年。 2. rTMS作用其SMA，頻率為1Hz，磁刺激強度為110％靜息閾值(resting motor threshold，RMT)，每天1200次脈沖，每周5天，連續(xù)4周。 3.于治療前及治療2周后、治療4周后3個時間點分別檢測左、右大腦半球RMT；治療前及治療2周后、治療4周后及治療后3月、治療后6月5個時間點分別進行耶魯抽動癥整體嚴重程度量表（Yale Global Tic Severity Scale，YGTSS），臨床療效總評量表（Clinical Global Impression，CGI），SNAP-IV量表（Swanson, Nolan, and Pelham, version IV scale for AHDH，SNAP-IV），Kovacs兒童抑郁量表（Kovacs Children's DepressionInventory，CDI），斯賓塞兒童焦慮量表（Spence Children’sAnxiety Scale，SCAS）及注意力測試（失誤率）評估。 結(jié)果： 1.除1例受試者有一過性輕微嗜睡外，其余24例未發(fā)現(xiàn)嚴重不良反應(yīng)，耐受性及安全性良好。19例臨床癥狀獲得改善，有效率76%。 2.治療2周后，YGTSS、CGI、CDI評分均值及注意力測試失誤率均較治療前顯著下降（P＜0.05），左、右大腦半球RMT較治療前顯著增高（P＜0.05）。 3.治療4周后，YGTSS、CGI、SNAP-IV、SCAS、CDI評分及注意力測試失誤率均較治療前顯著下降（P＜0.05），左、右大腦半球RMT較治療前顯著增高（P＜0.05）。 4.治療前后左、右大腦半球RMT沒有顯示出不對稱。 5.在治療后的6個月隨訪期內(nèi)，17例受試對象治療維持有效，有效率68%。 6.隨訪期內(nèi)3個月時，YGTSS、CGI、CDI、SCAS評分均值較治療4周后無顯著差異（P＞0.05），SNAP-IV評分均值及注意力測試失誤率均較治療4周后顯著下降（P＜0.05）。 7.隨訪期內(nèi)6個月時，YGTSS、CGI、CDI評分均值較治療4周后無顯著差異（P＞0.05），，SNAP-IV、SCAS評分均值及注意力測試失誤率均較治療4周后顯著下降（P＜0.05）。 結(jié)論： 1.1Hz、110%RMT低頻rTMS作用于藥物治療控制不佳的TS患兒SMA治療4周，治療期內(nèi)能有效改善其抽動癥狀。 2.采用20天的治療方案與既往10天方案報道相比，在治療后期能改善患兒的多動、抑郁及注意力不集中等相關(guān)癥狀。 3.本研究中，68%的患兒療效能有效維持6個月，有效提高患兒的生活質(zhì)量，改善患兒家庭關(guān)系，是一種有效的、安全的治療方法。 4. rTMS改善TS患兒癥狀可能與低頻刺激降低大腦皮層興奮性有關(guān)。
[Abstract]:Objective: to study the effect of 1Hz low frequency repetitive transcranial magnetic stimulation (repetitive transcranial magneticstimulation,rTMs) on the treatment of multiple tic syndrome (Tourette syndrome,TS) in children with multiple tic syndrome (Tourette syndrome,TS). Methods: 1. Twenty-five children aged between 7.2-15.4 years old with TS were collected. The course of disease was 1-6.5 years. The SMA, frequency was 1Hz and the magnetic stimulation intensity was 110% resting threshold (resting motor threshold,RMT), 1200 pulses per day, 5 days a week. 4 weeks in a row. 3. Left and right hemisphere RMT; were detected before and 2 weeks after treatment, 4 weeks and 3 months after treatment, respectively. Six months after treatment, five time points were treated with the Yale holistic severity scale (Yale Global Tic Severity Scale,YGTSS), the Clinical efficacy scale (Clinical Global Impression,CGI) and the SNAP-IV scale (Swanson, Nolan, and Pelham, version IV scale for AHDH,SNAP-IV), the Kovacs Children's Depression scale (Kovacs Children's DepressionInventory,CDI), and the Spenser Children's anxiety scale. (Spence Children'sAnxiety Scale,SCAS) and attention test (error rate) were evaluated. Results: 1. Except for one patient with transient mild somnolence, no severe adverse reactions were found in the remaining 24 cases. The clinical symptoms were improved in 19 patients with good tolerance and safety. The effective rate was 76.2%. After 2 weeks of treatment, the mean value of CGI CDI score and the rate of attention failure were significantly decreased (P < 0. 05), and the RMT in left and right hemisphere were significantly higher than that before treatment (P < 0. 05). After 4 weeks of treatment, the CDI score and attention test error rate of SNAP-IVP SCASI were significantly lower than those before treatment (P < 0. 05), and the RMT of left and right cerebral hemispheres were significantly higher than those before treatment (P < 0. 05). Left and right hemisphere RMT showed no asymmetry before and after treatment. During the follow-up period of 6 months after treatment, 17 patients were treated effectively and the effective rate was 68.6%. There was no significant difference (P > 0.05) in the mean value of SCAS score between YGTSS and CGII-CDIN after 4 weeks of treatment (P > 0.05). The mean value of SNAP-IV score and the failure rate of attention test were significantly lower than those after 4 weeks of treatment (P < 0.05). There was no significant difference in the mean value of CGI CDI score between the two groups after 4 weeks of treatment (P > 0.05). The mean score of SNAP-IVI SCAS and the failure rate of attention test were significantly lower than those after 4 weeks of treatment (P < 0.05). Conclusion: 1. 1. Low frequency rTMS of RMT can effectively improve the twitch symptoms of SMA in TS children who are not well controlled by drug therapy for 4 weeks. 2. Compared with the previous 10-day regimen, the 20-day treatment regimen improved hyperactivity, depression and attention-related symptoms in the later stage of treatment. 3. In this study, 68% of the children were effective in maintaining the curative effect for 6 months, effectively improving the quality of life and improving the family relationship of the children. Safe treatment. 4. The improvement of rTMS symptoms in children with TS may be associated with low-frequency stimulation and decreased cortical excitability.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R749.94

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