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目的:观察低频重复经颅磁刺激(rTMS)的抗癫疗效及可能机制。方法:对4例难治性癫患者灶所在脑区给予rTMS治疗(0.5 Hz,45%最大输出强度,每天15串、100次/串、串间隔30 s,连续10 d),观察治疗前后各3个月患者的临床发作及1 h时长的脑电图癫波数量,并行单光子发射断层摄影(SPECT)和静息运动阈值检查,以观察感兴趣区(ROI)放射线摄取比值的变化和皮质兴奋性改变。结果:4例患者经rTMS治疗后,3例无发作,1例发作1次。脑电图:1例癫波减少了20%;4例静息运动阈值均增高。SPECT:4例均显示rTMS后ROI值进一步降低。结论:低频rTMS对难治性癫有治疗作用,其抗癫作用可能与减少癫灶局部脑血流灌注和增加静息运动阈值有关。
Objective: To observe the anti-epileptic effect and possible mechanism of low-frequency repetitive transcranial magnetic stimulation (rTMS). Methods: The brain regions of 4 patients with refractory epilepsy were treated with rTMS (0.5 Hz, 45% maximal output intensity, 15 trains per day, 100 trains per trachea, 30 strokes per trachea for 10 days) The clinical seizures and the number of electroencephalographic epileptic waves at 1-hour intervals were performed in each 3-month patient. The single photon emission tomography (SPECT) and resting motor threshold were performed to observe the changes in the ratio of radiation uptake in ROI And cortical excitability changes. Results: After 4 patients were treated with rTMS, 3 patients had no attack and 1 patient had an attack. EEG: 1 case of epileptic wave decreased by 20%; 4 cases of resting motor threshold were increased. SPECT: All 4 cases showed further reduction of ROI after rTMS. Conclusion: Low-frequency rTMS can treat refractory epilepsy, and its antiepileptic effect may be related to the reduction of local cerebral blood flow perfusion and increase of resting movement threshold in epileptic patients.