论文部分内容阅读
目的探讨高频重复经颅磁刺激(rTMS)不同靶点治疗带状疱疹后遗神经痛(PHN)的疗效。方法 PHN患者60例,病程6~12个月,均分为前额叶背外侧皮质(DLPFC)区组(DLPFC组)、初级运动皮质(M1)区组(M1组)和假刺激组。DLPFC组在左侧大脑DLPFC区给予rTMS,M1组在疼痛对侧大脑M1区给予rTMS,假刺激组在头顶中心点(脑电图CZ点)给予假刺激。rTMS参数:频率10Hz,强度80%静息运动阈值,刺激5s,间歇3s。共300个串1500次脉冲。每周5次,连续治疗4周。比较三组治疗前后VAS疼痛评分、匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评分。结果治疗4周后,DLPFC组、M1组VAS疼痛、PSQI、SAS和SDS评分均较假刺激组及治疗前改善(P<0.05);DLPFC组PSQI评分和SAS评分均优于M1组[(4.9±1.4)分vs.(6.4±2.2)分和(44.4±8.7)分vs.(49.8±8.0)分](P<0.05)。结论大脑M1区和DLPFC区的高频rTMS对PHN均有疗效;其中,DLPFC区作为刺激靶点对患者睡眠和焦虑症状的改善更明显。
Objective To investigate the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on different targets in the treatment of postherpetic neuralgia (PHN). Methods Sixty patients with PHN were enrolled in this study. The course of the disease was 6-12 months. The patients were divided into DLPFC group (DLPFC group), M1 group (M1 group) and sham stimulation group. The DLPFC group was given rTMS in the DLPFC area of the left brain, while the M1 group was given rTMS in the M1 area of the contralateral brain. The sham stimulation group was given sham stimulation at the center of the head (EEG CZ point). rTMS parameters: Frequency 10Hz, intensity 80% resting motion threshold, stimulation 5s, intermittent 3s. A total of 300 strings 1500 times the pulse. 5 times a week, continuous treatment for 4 weeks. VAS pain score, Pittsburgh Sleep Quality Index (PSQI), anxiety self-rating scale (SAS) and depression self-rating scale (SDS) were compared between the three groups before and after treatment. Results The scores of VAS pain, PSQI, SAS and SDS of DLPFC group and M1 group were significantly higher than those of sham stimulation group and before treatment (P <0.05) after 4 weeks of treatment. PSQI score and SAS score of DLPFC group were better than those of M1 group [(4.9 ± 1.4) vs (6.4 ± 2.2) vs (44.4 ± 8.7) vs (49.8 ± 8.0) points (P <0.05). Conclusions The high frequency rTMS in the M1 and DLPFC areas of the brain is effective for PHN. Among them, the improvement of sleep and anxiety symptoms in DLPFC area as the target of stimulation is more obvious.