Mov Disord : 多靶点经颅电刺激,治疗冻结步态,效果如何

2021-09-24 Freeman MedSci原创

在轻度至中度FOG严重程度的参与者中观察到的改善值得进一步研究。在轻度至中度FOG严重程度的参与者中观察到的改善值得进一步研究。

步态冻结(FOG)是帕金森病(PD)的典型症状之一。

目前的治疗方法是有限的,需要新的疗法。除了纹状体和小脑运动区的皮质下功能障碍外,最近的研究表明,FOG还与前额叶认知和感觉运动网络的功能障碍有关。

经颅直接电流刺激(tDCS)可调节皮质神经元及其连接的神经网络的兴奋性。试点工作表明,旨在促进初级运动皮层(M1)兴奋性的TDCS可减少FOG,针对左背外侧前额叶皮层(dlPFC)的TDCS可改善执行功能和认知要求 "双任务(dual-task) "条件下的步态,并且TDCS可改善自我报告的FOG严重程度。

美国Hinda and Arthur Marcus Institute for Aging Research的Brad Manor等人, 对20名患有FOG的PD患者进行的试点研究中,与M1或假刺激相比,针对左dlPFC和M1的单次TDCS刺激后立即明显降低了FOG的严重程度。
基于这一证据和认知-运动联系在FOG中的推定作用,他们进行了一项随机对照试验,以测试针对左dlPFC和M1的多疗程TDCS干预会减少FOG和改善相关结果的假设。

77名患有帕金森病的FOG患者参加了一项双盲随机试验。TDCS和假性干预包括2周内的10次治疗,然后是每周一次的5次治疗。评估了FOG诱发试验的表现(主要结果)、功能结果和自我报告的FOG严重程度。

主要分析表明,TDCS在FOG诱发试验中没有优势。

在次要分析中,与对照相比,TDCS减少了自我报告的FOG严重程度,增加了日常生活的步数。在轻度至中度FOG严重程度的人中,TDCS改善了FOG诱发测试时间和FOG的自我报告。

针对左背外侧前额叶皮层和M1的多疗程TDCS没有改善基于实验室的FOG诱发测试表现。在轻度至中度FOG严重程度的参与者中观察到的改善值得进一步研究。

 

原文出处:
Manor B, Dagan M, Herman T, et al. Multitarget Transcranial Electrical Stimulation for Freezing of Gait: A Randomized Controlled Trial. Mov Disord. Published online August 18, 2021:mds.28759. doi:10.1002/mds.28759

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    2022-08-06 zhangph
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    2022-08-09 xxxx1061
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    2022-08-19 cmsvly
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