摘要：

目的 探讨低频重复经颅磁刺激（rTMS）治疗帕金森病伴疼痛的有效性和安全性。方法 2016 年 6 月至 2018 年 6 月共治疗 56 例帕金森病伴疼痛患者，随机分为常规药物治疗并假刺激组（对照组）和常规药物辅助低频（0.50 Hz）重复经颅磁刺激组（rTMS 组），并根据统一帕金森病评价量表（UPDRS）、视觉模拟评分（VAS）、国王帕金森病疼痛评价量表（KPPS）以及汉密尔顿抑郁量表 24 项（HAMD-24）评分评价疗效，记录不良事件。结果 两组患者治疗后 VAS 评分（F = 15.398，P = 0.000）和KPPS 评分（F = 13.483，P = 0.001）低于治疗前，其中 KPPS 量表仅骨骼肌疼痛（F = 8.245，P = 0.008）、慢性疼痛（F = 7.376，P = 0.007）和神经根性疼痛（F = 3.156，P = 0.008）评分治疗后低于治疗前；治疗后rTMS 组VAS 评分（F = 6.237，P = 0.045）和 KPPS 评分（F = 343.872，P = 0.000）低于对照组，其中 KPPS 量表仅骨骼肌疼痛（F = 7.145，P = 0.020）和慢性疼痛（F = 6.325，P = 0.014）评分低于对照组。治疗期间 rTMS 组出现短暂性血压升高（1 例）和短暂性头痛（1 例），两组不良事件发生率差异无统计学意义［7.14%（2/28）对 0（0/28）；校正χ² = 0.519，P = 0.471］。结论 低频重复经颅磁刺激治疗帕金森病伴疼痛疗效确切，尤以缓解骨骼肌疼痛和慢性疼痛效果最佳，远期效果尚待进一步观察，安全性良好，但作用机制尚不明确。

关键词: 帕金森病, 疼痛, 经颅磁刺激

Abstract:

Objective To investigate the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation (rTMS) on Parkinson's disease (PD) patients associated with pain. Methods Fifty-six PD patients associated with pain were enrolled from June 2016 to June 2018. They were given conventional drug treatment and sham stimulation (control group, N = 28) or low-frequency (0.50 Hz) rTMS on the basis of conventional drug treatment (rTMS group, N = 28). The Unified Parkinson's Disease Rating Scale (UPDRS), Visual Analogue Scale (VAS), King's Parkinson Disease Pain Scale (KPPS) and Hamilton Depression Rating Scale-24 Items (HAMD-24) were used to evaluate the therapeutic effect and adverse events were recorded. Results The VAS (F = 15.398, P = 0.000) and KPPS scores (F = 13.483, P = 0.001) after treatment were significantly lower than before treatment in 2 groups, in which the KPPS only had lower scores of skeletal muscle pain (F = 8.245, P = 0.008), chronic pain (F= 7.376, P = 0.007) and nerve root pain (F = 3.156, P = 0.008). Compared with control group, the VAS (F = 6.237, P = 0.045) and KPPS scores (F = 343.872, P = 0.000) after treatment were lower in the rTMS group, in which the KPPS only had lower scores of skeletal muscle pain (F = 7.145, P = 0.020) and chronic pain (F = 6.325, P = 0.014). There were one case of transient blood pressure elevation and one case of transient headache in rTMS group during treatment. There was no significant difference in the incidence of adverse events between 2 groups [7.14% (2/28) vs. 0 (0/28); adjusted χ² = 0.519, P = 0.471]. Conclusions The effect of low-frequency rTMS for PD with pain is evident, especially to relieve skeletal muscle pain and chronic pain. The long-term effect needs further observation, and the safety is good, while the mechanism of action is still unclear.

Key words: Parkinson disease, Pain, Transcranial magnetic stimulation