重复性经颅磁刺激治疗Tourette综合征疗效及安全性研究

摘要

Objective To explore and analyze the effect and safety of treatment in Tourette Syndrome( TS)with repetitive transcranial magnetic stimulate. Methods 30 TS cases of out - patient children were selected retrospectively into this study. All patients did not show effective treatment after one drug therapy. The study group were treated by rTMS combined with original medicine. The parameters of rTMS treatment included effect on supplementary motor area,giving a frequency of 0. 5HZ,magnetic field strength is 50% ~70% of motor threshold. There were 60 sequences,20 pulses per sequence. A total pulses were 1 200. The patients were treated with rTMS for 10 daily sessions. The patients were respectively detected by Yale Global Tourtte's Syndrome Severity Scale(YGTSS )before and after the intervention immediately,28 days and 56 days after treatment. Results ①The tics symptoms of 7 patients were improved,effectively improved in 3 patients. 3 patients were cured after immediate treatment. The tics symptoms of 7 patients were improved,effective improved in 7 patients. 3 patients were cured 28 days after treatment of rTMS. The tics symptoms of 7 patients were improved,effective improved in 10 patients. 3 patients were cured 56 days after treatment of rTMS. Total efficiency was 66. 67%. ②The vocal tic reduction rate was significantly higher than that of motor tics of the reduction rate with rTMS( P ﹤0. 01). ③All patients were tolerate to the treatment without side - effects. Conclusion Low - frequence rTMS over the SMA was an effective adjuvant therapy on TS. The improvement of vocal tics was significant than that of motor tics. Less adverse reactions were reported during treatment.%目的探讨重复性经颅磁刺激治疗儿童Tourette综合征（ TS）疗效及安全性。方法选择首都儿科研究所附属儿童医院神经内科门诊确诊的TS患儿30例，病程超过1年，正规药物治疗无效。在原药治疗基础上应用重复性经颅磁刺激（ rTMS）治疗。rTMS治疗参数：rTMS作用于辅助运动区（ Cz前方3 cm），给予频率为0.5 Hz，磁场强度为50%~70%运动阈值，每序列20次脉冲，序列间隔2 s，60个序列，共1200次脉冲，一次性连续刺激。共治疗10天。rT-MS治疗前以及治疗后即刻、第4、8周内分别进行耶鲁综合抽动严重程度量表（ YGTSS）评估。结果①治疗后即刻症状好转7例，显效、痊愈各3例；治疗后4周好转7例，显效7例，痊愈3例；治疗后8周好转7例，显效10例，痊愈3例，总有效率66.67%。②rTMS对发声抽动治疗的有效率显著高于运动抽动治疗的有效率（ P ﹤0.001）。③所有患儿均能耐受治疗过程，无不良反应。结论应用低频的rTMS对辅助运动区进行刺激是辅助治疗TS的有效方法，本治疗方法对发声性抽动的改善情况明显好于运动性抽动。治疗过程不良反应少。