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目的 :采用经颅磁刺激(transcranial magnetic stimulation,TMS)法评估长病程随访和初诊原发性帕金森病(Parkinson′s disease,PD)患者的运动诱发电位(motor-evoked potentials,MEP),探究长期PD病理改变对大脑皮层兴奋性和中枢神经传导的影响。方法:选择病程>8年的PD患者和初诊未服药的PD患者各7例,采用统一帕金森病评定量表运动部分(Unified Parkinson′s Disease Rating ScaleⅢ,UPDRS-Ⅲ)评估其运动功能,并用简易精神状态量表评估其认知功能,通过TMS检测其双侧静息运动阈值(resting motor threshold,RMT)、活动运动阈值(active motor threshold,AMT)、MEP波幅和中枢传导时间(central motor conduction time,CMCT),根据每位患者症状重侧和轻侧进行双侧对比和组间比较。结果:RMT、AMT、MEP波幅及CMCT在长病程PD患者与初诊PD患者间,以及在每位患者症状重侧与症状轻侧之间的差异均无统计学意义(P>0.05)。全体PD患者症状轻侧的CMCT与其UPDRS-Ⅲ总分及症状轻侧得分呈正相关(P<0.05);而在长病程组中,患者症状重侧的CMCT与症状重侧的UPDRS-Ⅲ得分间呈正相关(P<0.05)。结论:长病程PD并不改变患者的皮层兴奋性,但其中枢传导速度可能随疾病发展而降低。
Objective: To evaluate the motor-evoked potentials (MEP) in patients with long-term follow-up and newly diagnosed Parkinson’s disease (PD) using transcranial magnetic stimulation (TMS) Effect of chronic PD pathologic changes on excitability and CNS conduction in cerebral cortex. Methods: Seven patients with PD of 8 years and 7 patients with newly diagnosed PD were enrolled in this study. Their motor function was evaluated by the Unified Parkinson’s Disease Rating Scale Ⅲ (UPDRS-Ⅲ) The simple mental status scale was used to evaluate the cognitive function. The resting motor threshold (RMT), active motor threshold (AMT), MEP amplitude and central motor conduction time, CMCT) was used to compare bilateral and side-to-side comparisons based on each patient’s symptoms. Results: There were no significant differences in the amplitudes of RMT, AMT, MEP and CMCT between long-term PD patients and newly diagnosed PD patients, as well as between the patients with symptomatic side and mild side (P> 0.05). The scores of CMCT on the mild side of all patients with PD were positively correlated with their UPDRS-III scores and mild side scores (P <0.05). However, in patients with long-term courses, (P <0.05). Conclusion: Long duration PD does not change the cortical excitability of patients, but its central conduction velocity may decrease with the development of the disease.