摘要：

研究背景 既往研究显示，初级运动皮质予重复经颅磁刺激可以改善皮质脊髓束损害。本研究采用三重刺激技术定量评价2 例以帕金森综合征为主要表现的多系统萎缩（MSA-P）患者重复经颅磁刺激前后皮质脊髓束功能变化，探讨重复经颅磁刺激对皮质脊髓束损害的改善作用。 方法 2 例MSA-P 型患者（1 例为62 岁男性，1 例为44 岁女性），病程1 年，均接受重复经颅磁刺激，采用小指展肌三重刺激技术波幅比和统一多系统萎缩评价量表第二部分（UMSARSⅡ）评价治疗前后皮质脊髓束功能和运动功能。 结果 2 例MSA-P 型患者治疗前小指展肌三重刺激技术波幅比为28.30%和69.10%，UMSARSⅡ评分22 和20 分；治疗后即刻小指展肌三重刺激技术波幅比为58.40%和71.70%，UMSARSⅡ评分16 和12 分，其中例1 随访至重复经颅磁刺激后2 个月，治疗后1 和2 个月小指展肌三重刺激技术波幅比分别为90.70%和50.70%，UMSARSⅡ评分17 和23 分。 结论 采用三重刺激技术可以定量评价重复经颅磁刺激对MSA-P 型患者皮质脊髓束损害的改善作用。

关键词: 诱发电位, 多系统萎缩, 经颅磁刺激

Abstract:

Background  Previous studies suggest that the cortico-spinal tract can be modulated by M1 repetitive transcranial magnetic stimulation (rTMS). However, it is not well investigated in patients with multiple system atrophy (MSA). We discuss 2 cases of MSA with parkinsonism-predominant (MSA-P), who have been evaluated the function of cortico-spinal tract using triple stimulation technique (TST) before and after rTMS, so as to explore the effect of rTMS on improving the damage of cortico-spinal tract.  Methods Two MSA-P patients (one 62-year-old male, one 44-year-old female) with disease course of one year were examined with TST at abductor digiti minimi. TST amplitude ratio and the motor score of Unified Multiple System Atrophy Rating Scale (UMSARSⅡ) were used to assess the damage of cortico-spinal tract and motor function before and after rTMS treatment.  Results  TST amplitude ratio at abductor drgiti minimi of both patients was 28.30% and 69.10%, and UMSARS Ⅱ score was 22 and 20 before treatment. Immediately after rTMS the amplitude ratio was 58.40% and 71.70% , and UMSARS Ⅱ score was 16 and 12, respectively. The improvement sustained in Case one in the next month (TST amplitude ratio 90.70% , UMSARS Ⅱ score 17) and the second month (TST amplitude ratio 50.70% , UMSARS Ⅱ score 23).  Conclusions  TST can be used to quantitatively evaluate the integrity of cortico-spinal tract after rTMS.

Key words: Evoked potentials, Multiple system atrophy, Transcranial magnetic stimulation