经颅直流电刺激对帕金森病患者平衡功能的影响
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摘要
目的:观察经颅直流电刺激(tDCS)对帕金森病患者平衡功能的影响。方法:采用双盲、随机、对照研究的方法,利用SPSS 20.0统计软件中随机数字生成器对符合入选标准的49例帕金森病患者进行分组,分为干预组25例和对照组24例。2组在常规药物和康复治疗的基础上,分别给予tDCS治疗和安慰tDCS治疗,tDCS阳极电极置于左侧背外侧前额叶皮层,阴极电极置于右侧眶前额叶,2组分别接受20 min/d、连续5 d的治疗,治疗时干预组电流为2 mA,而对照组作为安慰治疗,仅在治疗起始和结束前30 s电流为2 mA,其他时间电流为0 mA。在治疗前和治疗5 d后,应用Berg平衡量表(BBS)、NeuroCom平衡系统(参数包括6种不同条件下的平衡测评值)进行测评。结果:2组治疗前BBS评分、NeuroCom平衡系统中6种平衡条件下的平衡结果测评值比较,差异无统计学意义(P>0.05)。治疗5 d后,干预组BBS评分为(52.24±4.04)分,较治疗前(50.44±4.89)分有改善,差异有统计学意义(P<0.05);对照组BBS评分为(51.96±4.11)分,较治疗前(49.75±4.74)分有改善,差异有统计学意义(P<0.05);2组治疗后BBS评分比较,差异无统计学意义(P>0.05)。治疗5 d后,干预组NeuroCom平衡系统平衡条件①、②、③和⑤下的测评值与治疗前比较,差异无统计学意义(P>0.05),而NeuroCom平衡系统平衡条件④和⑥下的测评值分别为(73.21±8.89)分和(37.42±26.46)分,优于治疗前(64.72±13.93)分和(31.09±29.28)分,差异有统计学意义(P<0.05);对照组NeuroCom平衡系统平衡条件①、②、③、④、⑤和⑥下的测评值与治疗前比较,差异均无统计学意义(P>0.05)。结论:tDCS可增强帕金森病患者的视空间处理能力和前庭功能,从而提高其平衡能力。
Objective: To observe the improvement of balance function in patients with Parkinson's disease treated by transcranial direct current stimulation(tDCS). Methods: With double-blind, random and control studies, using the random number generator in SPSS 20.0 statistical software, a total of 49 patients with Parkinson's disease who met the inclusion criteria were divided into intervention group(n=25) and control group(n=24). In addition to the routine treatment, both of groups were given the treatment of t DCS respectively. Anode electrode of t DCS was placed over the left dorsolateral prefrontal cortex, and cathode electrode of t DCS was placed over the right orbital frontal cortex. Two groups were treated once a day, 20 min per time, and for 5 consecutive days. The difference between two groups was that the current intensity of the intervention group was 2 m A, while acting as a placebo condition, the current intensity of the control group was 2 m A only at the first and last 30 s during the treatment, the rest of time was 0 m A. Before and after 5 days, patients with Parkinson's disease were evaluated by scales in terms of Berg Balance Scale(BBS) and NeuroCom Balance system(parameters including scores of balance test under six conditions). Results: Before treatment, there was no statistically significant difference between the two groups on BBS scores and the balance results of the 6 kinds of balance conditions in the NeuroCom Balance system(P>0.05). After five days' treatment, BBS scores(52.24±4.04) of the intervention group were improved compared with those(50.44± 4.89) before treatment, and the difference was statistically significant(P<0.05); the BBS scores(51.96± 4.11) of the control group were improved compared with those(49.75±4.74) before treatment, and the difference was statistically significant(P<0.05);there was not statistically significant in the BBS scores after treatment between the two groups(P>0.05). After five days' treatment,the evaluation values of NeuroCom Balance system of condition ①, ②, ③ and ⑤ in the intervention group were not statistically significant(P>0.05); the evaluation values of NeuroCom Balance system of condition ④(73.21±8.89) and ⑥(37.42±26.46) in the intervention group were statistically significant than before(64.72±13.93) and(31.09±29.28)(P<0.05). The evaluation values of NeuroCom Balance system of condition ①, ②, ③, ④, ⑤ and ⑥ in the control group were not statistically significant(P>0.05). Conclusion:t DCS could enhance the visual spatial processing and vestibular function in patients with Parkinson's disease and improve the ability with their balance.
Objective: To observe the improvement of balance function in patients with Parkinson's disease treated by transcranial direct current stimulation(tDCS). Methods: With double-blind, random and control studies, using the random number generator in SPSS 20.0 statistical software, a total of 49 patients with Parkinson's disease who met the inclusion criteria were divided into intervention group(n=25) and control group(n=24). In addition to the routine treatment, both of groups were given the treatment of t DCS respectively. Anode electrode of t DCS was placed over the left dorsolateral prefrontal cortex, and cathode electrode of t DCS was placed over the right orbital frontal cortex. Two groups were treated once a day, 20 min per time, and for 5 consecutive days. The difference between two groups was that the current intensity of the intervention group was 2 m A, while acting as a placebo condition, the current intensity of the control group was 2 m A only at the first and last 30 s during the treatment, the rest of time was 0 m A. Before and after 5 days, patients with Parkinson's disease were evaluated by scales in terms of Berg Balance Scale(BBS) and NeuroCom Balance system(parameters including scores of balance test under six conditions). Results: Before treatment, there was no statistically significant difference between the two groups on BBS scores and the balance results of the 6 kinds of balance conditions in the NeuroCom Balance system(P>0.05). After five days' treatment, BBS scores(52.24±4.04) of the intervention group were improved compared with those(50.44± 4.89) before treatment, and the difference was statistically significant(P<0.05); the BBS scores(51.96± 4.11) of the control group were improved compared with those(49.75±4.74) before treatment, and the difference was statistically significant(P<0.05);there was not statistically significant in the BBS scores after treatment between the two groups(P>0.05). After five days' treatment,the evaluation values of NeuroCom Balance system of condition ①, ②, ③ and ⑤ in the intervention group were not statistically significant(P>0.05); the evaluation values of NeuroCom Balance system of condition ④(73.21±8.89) and ⑥(37.42±26.46) in the intervention group were statistically significant than before(64.72±13.93) and(31.09±29.28)(P<0.05). The evaluation values of NeuroCom Balance system of condition ①, ②, ③, ④, ⑤ and ⑥ in the control group were not statistically significant(P>0.05). Conclusion:t DCS could enhance the visual spatial processing and vestibular function in patients with Parkinson's disease and improve the ability with their balance.
引文
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[6]中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业.中国帕金森病的诊断标准(2016版)[S].中华神经科杂志,2016,49(4):268-271.
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[8] LATTARI E,COSTA S S,CAMPOS C,et al. Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease?[J].Neurosci Lett,2017,636:165-169.
[9] KLEM G H,LUDERS H O,JASPER H H,et al. The ten-twenty electrode system of the International Federation. The International Federation of Clinical Neurophysiology[J]. Electroencephalogr Clin Neurophysiol Suppl,1999,52:3-6.
[10] NITSCHE M A,COHEN L G,WASSERMANN E M,et al. Transcranial direct current stimulation:State of the art 2008[J]. Brain Stimul,2008,1(3):206-223.
[11] PICKENBROCK H M,DIEL A,ZAPF A. A comparison between the Static Balance Test and the Berg Balance Scale:validity,reliability,and comparative resource use[J]. Clin Rehabil,2016,30(3):288-293.
[12] GERA G,FREEMAN D L,BLACKINTON M T,et al. Identification of balance deficits in people with Parkinson’s disease;is the sensory organization test enough?[J]. Int J Phys Med Rehabil,2016,4(1):322.
[13] YEH J R,HSU L C,LIN C,et al. Nonlinear analysis of sensory organization test for subjects with unilateral vestibular dysfunction[J]. PLoS One,2014,9(3):e91230.
[14]卢健军,潘梦秋,王玉周,等.早期帕金森病患者动态姿态平衡检查分析[J].中国神经精神疾病杂志,2014,40(10):612-615.
[15] LEE J M,KOH S B,CHAE S W,et al. Postural instability and cognitive dysfunction in early Parkinson’s disease[J]. Can J Neurol Sci,2012,39(4):473-482.
[16] BRUNONI A R,AMADERA J,BERBEL B,et al. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation[J]. Int J Neuropsychoph,2011,14(8):1133-1145.
[17] HADOUSH H,AL-JARRAH M,KHALIL H A,et al. Bilateral anodal transcranial direct current stimulation effect on balance and fearing of fall in patient with Parkinson’s disease[J]. Neuro Rehabilitation, 2018,42(1):63-68.
[18]王玉龙.康复功能评定学[M]. 2版.北京:人民卫生出版社,2015:244-245.
[19] LITHGOW B J,SHOUSHTARIAN M. Parkinson’s disease:disturbed vestibular function and levodopa[J]. J Neurol Sci,2015,353(1/2):49-58.
[2] WIELINSKI C L,ERICKSON-DAVIS C,WICHMANN R,et al.Falls and injuries resulting from falls among patients with Parkinson’s disease[J]. Mov Disord,2005,20(4):410-415.
[3] COSENTINO G,VALENTINO F,TODISCO M,et al. Effects of more-affected vs. less-affected motor cortex tDCS in Parkinson’s disease[J]. Front Hum Neurosci,2017,11:309.
[4] FREGNI F,BOGGIO P S,SANTOS M C,et al. Noninvasive cortical stimulation with transcranial direct current stimulation in Parkinson’s disease[J]. Mov Disord,2006,21(10):1693-1702.
[5] VALENTINO F,COSENTINO G,BRIGHINA F,et al. Transcranial direct current stimulation for treatment of freezing of gait:A cross-over study[J]. Movement Disord,2014,29(8):1064-1069.
[6]中华医学会神经病学分会帕金森病及运动障碍学组,中国医师协会神经内科医师分会帕金森病及运动障碍专业.中国帕金森病的诊断标准(2016版)[S].中华神经科杂志,2016,49(4):268-271.
[7]中华医学会神经病学分会运动障碍及帕金森病学组.中国帕金森病治疗指南(第三版)[S].中华神经科杂志,2014,47(6):428-433.
[8] LATTARI E,COSTA S S,CAMPOS C,et al. Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease?[J].Neurosci Lett,2017,636:165-169.
[9] KLEM G H,LUDERS H O,JASPER H H,et al. The ten-twenty electrode system of the International Federation. The International Federation of Clinical Neurophysiology[J]. Electroencephalogr Clin Neurophysiol Suppl,1999,52:3-6.
[10] NITSCHE M A,COHEN L G,WASSERMANN E M,et al. Transcranial direct current stimulation:State of the art 2008[J]. Brain Stimul,2008,1(3):206-223.
[11] PICKENBROCK H M,DIEL A,ZAPF A. A comparison between the Static Balance Test and the Berg Balance Scale:validity,reliability,and comparative resource use[J]. Clin Rehabil,2016,30(3):288-293.
[12] GERA G,FREEMAN D L,BLACKINTON M T,et al. Identification of balance deficits in people with Parkinson’s disease;is the sensory organization test enough?[J]. Int J Phys Med Rehabil,2016,4(1):322.
[13] YEH J R,HSU L C,LIN C,et al. Nonlinear analysis of sensory organization test for subjects with unilateral vestibular dysfunction[J]. PLoS One,2014,9(3):e91230.
[14]卢健军,潘梦秋,王玉周,等.早期帕金森病患者动态姿态平衡检查分析[J].中国神经精神疾病杂志,2014,40(10):612-615.
[15] LEE J M,KOH S B,CHAE S W,et al. Postural instability and cognitive dysfunction in early Parkinson’s disease[J]. Can J Neurol Sci,2012,39(4):473-482.
[16] BRUNONI A R,AMADERA J,BERBEL B,et al. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation[J]. Int J Neuropsychoph,2011,14(8):1133-1145.
[17] HADOUSH H,AL-JARRAH M,KHALIL H A,et al. Bilateral anodal transcranial direct current stimulation effect on balance and fearing of fall in patient with Parkinson’s disease[J]. Neuro Rehabilitation, 2018,42(1):63-68.
[18]王玉龙.康复功能评定学[M]. 2版.北京:人民卫生出版社,2015:244-245.
[19] LITHGOW B J,SHOUSHTARIAN M. Parkinson’s disease:disturbed vestibular function and levodopa[J]. J Neurol Sci,2015,353(1/2):49-58.