中国神经再生研究(英文版)

中国神经再生研究(英文版) ›› 2022, Vol. 17 ›› Issue (5): 1051-1058.doi: 10.4103/1673-5374.324863

• 原著:脑损伤修复保护与再生 • 上一篇    下一篇

重复经颅磁刺激帕金森病吞咽障碍患者后尾状核及海马旁回激活增强：病例对照试验

  

  • 出版日期:2022-05-15 发布日期:2021-11-09

Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson’s disease patients with dysphagia after repetitive transcranial magnetic stimulation: a case-control study

Pei-Ling Huang1, #, Song-Jian Wang2, #, Rui-Feng Sun3, Zi-Man Zhu3, Xiao-Ling Li3, Wen-Shan Li3, Meng-Yue Wang2, Meng Lin2, Wei-Jun Gong1, *   

  1. 1Department of Neurological Rehabilitation, Beijing Rehabilitation Hospital of Capital Medical University, Beijing, China; 2Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, School of Biomedical Engineering, Capital Medical University, Beijing, China; 3Department of Neurological Rehabilitation, Beijing Rehabilitation Medicine Academy, Capital Medical University, Beijing, China
  • Online:2022-05-15 Published:2021-11-09
  • Contact: Wei-Jun Gong, PhD, gwj197104@ccmu.edu.cn.
  • Supported by:
    This work was supported by the Beijing Municipal Science and Technology Commission Capital Clinical Feature Applied Research Project of China, No. Z181100001718205 (to WJG and PLH).

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摘要：

重复经颅磁刺激能有效治疗帕金森病吞咽障碍，但对其如何影响帕金森病吞咽障碍患者相应脑区改变目前知之甚少。此次回顾性病例对照试验在首都医科大学北京康复医院招募了38例帕金森病吞咽障碍患者，于皮质运动区进行了连续10d的高频重复经颅磁刺激，1次/d，然后行功能磁共振观察，并与健康志愿者进行比较。结果发现，帕金森病吞咽障碍患者治疗前双侧中央前回、辅助运动区和小脑激活强度高于健康志愿者，但在治疗后减弱；而海马旁回、尾状核和左侧丘脑激活低于健康志愿者，并在治疗后增强；同时右侧丘脑激活高于健康志愿者，且治疗后增强。此外，帕金森病吞咽障碍患者经过重复经颅磁刺激治疗后主观吞咽感受改善。提示皮质运动区高频重复经颅磁刺激后，帕金森病合并吞咽障碍的患者的吞咽状况显著改善，其机制可能与尾状核及海马旁回激活增强有关。研究方案于2018年5月6日经首都医科大学北京康复医院伦理委员会批准（批准号2018bkky017），并于2018年7月18日在中国临床试验注册中心（注册号ChiCTR 1800017207）。

https://orcid.org/0000-0002-9134-8218 (Wei-Jun Gong)

关键词: 吞咽困难, 帕金森病, 重复经颅磁刺激, 功能磁共振, 脑区, 吞咽任务, 中央前回, 尾状核, 海马旁回, 临床试验

Abstract: Repetitive transcranial magnetic stimulation (rTMS) has been shown to effectively improve impaired swallowing in Parkinson’s disease (PD) patients with dysphagia. However, little is known about how rTMS affects the corresponding brain regions in this patient group. In this case-control study, we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy, Capital Medical University. The patients received high-frequency rTMS of the motor cortex once per day for 10 successive days. Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls. The results revealed that before treatment, PD patients with dysphagia showed greater activation in the precentral gyrus, supplementary motor area, and cerebellum compared with healthy controls, and this enhanced activation was weakened after treatment. Furthermore, before treatment, PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus, caudate nucleus, and left thalamus compared with healthy controls, and this activation increased after treatment. In addition, PD patients with dysphagia reported improved subjective swallowing sensations after rTMS. These findings suggest that swallowing function in PD patients with dysphagia improved after rTMS of the motor cortex. This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus. The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University (approval No. 2018bkky017) on March 6, 2018 and was registered with Chinese Clinical Trial Registry (registration No. ChiCTR 1800017207) on July 18, 2018.

Key words: brain regions, caudate, clinical trial, dysphagia, functional magnetic resonance imaging, parahippocampal gyrus, Parkinson’s disease, precentral gyrus, repetitive transcranial magnetic stimulation, saliva swallowing task

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