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目的探讨经颅磁刺激方法对帕金森病患者睡眠结构及睡眠质量的影响。方法对2006年9月至2007年12月河北医科大学第一医院神经内科收治的15例已确诊,Hoehn-Yahr分期在1～2期的帕金森病患者进行经颅磁刺激治疗,治疗前后分别进行国际统一帕金森病量表评测及多导睡眠脑电监测。结果15例帕金森病患者的临床评分(UPDRS)由治疗前的38.83±16.72下降到25.09±11.10,差异有统计学意义(P<0.05),多导睡眠监测显示,患者的总睡眠时间由治疗前的(318.35±92.49)min增加到(333.9±59.04)min,虽然有增加趋势,但差异无统计学意义。入睡潜伏期由治疗前的(53.50±46.40)min减少到(30.43±23.91)min,较治疗前明显缩短,差异有统计学意义(P<0.05)。治疗后患者进入Ⅰ期睡眠后维持时间减少,但差异无统计学意义;进入Ⅱ期睡眠维持时间较治疗前无明显变化,个别患者能够进入Ⅲ期、Ⅳ期睡眠,可持续数分钟。睡眠效率、中间觉醒时间、快速动眼(REM)期睡眠和REM期潜伏期治疗前后差异均无统计学意义。结论在刺激频率为0.5Hz,最大刺激强度为2.0T,给予阈上30%的刺激强度下的经颅磁刺激能缩短帕金森病患者睡眠潜伏期,并可能会增加深睡期时间,但对帕金森病的睡眠结构无明确的调整作用。
Objective To investigate the effects of transcranial magnetic stimulation on sleep structure and sleep quality in patients with Parkinson’s disease. Methods From September 2006 to December 2007, 15 cases of Parkinson’s disease with confirmed Hoehn-Yahr stage 1 to 2 in the Department of Neurology, the First Hospital of Hebei Medical University were treated with transcranial magnetic stimulation before and after treatment To carry out the international assessment of Parkinson’s disease scale and polysomnography. Results The clinical scores (UPDRS) of 15 patients with Parkinson’s disease decreased from 38.83 ± 16.72 before treatment to 25.09 ± 11.10, the difference was statistically significant (P <0.05), polysomnography showed that the total sleep time of patients was Before (318.35 ± 92.49) min increased to (333.9 ± 59.04) min, although there is an increasing trend, but the difference was not statistically significant. The latency to fall asleep decreased from (53.50 ± 46.40) min to (30.43 ± 23.91) min before treatment, which was significantly shorter than before treatment (P <0.05). After treatment, the maintenance time of patients entering stage I sleep decreased, but the difference was not statistically significant. The stage II sleep maintenance time did not change significantly before treatment, and some patients could enter stage III and IV sleep for several minutes. There was no significant difference in sleep efficiency, middle awakening time, rapid eye movement (REM) sleep latency and REM latency before and after treatment. Conclusion Transcranial magnetic stimulation at a stimulation frequency of 0.5 Hz and a maximum stimulation intensity of 2.0 T at a threshold intensity of 30% can shorten the sleep latency of patients with Parkinson’s disease and may increase the duration of deep sleep. However, There is no clear adjustment effect on the structure of sleep in patients with Parkinson’s disease.