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目的观察低频及阈下强度的重复经颅磁刺激治疗难治性癫痫的疗效。方法采用重复经颅磁刺激治疗12例难治性局灶性癫癎患者,分析并评价治疗前后癫癎发作频率、发作日及发作潜伏期;采集治疗前后脑电信号,分析脑电图各频带相对功率值(%)和尖波发放数目。结果 12例患者经低频重复经颅磁刺激首次治疗后,癫癎发作频率及发作日均减少(t=2.450,P=0.032;t=2.797,P=0.017),其中8例发作潜伏期延长。脑电图δ频带相对功率值(6%)降低(t=3.047,P=0.011)、B频带相对功率值(β%)增加(t=-2.703,P=0.021),尤以α频带相对功率值(α%)增加显著(t=3.680,P=0.004);脑电图尖波发放数目减少(t=2.411,P=0.035)。再次治疗后上述指标仍呈改善趋势,δ%降低、α%增幅变大,尤其δ%降低幅度增加至2.08倍,背景波明显改善。结论采用低频、阈下强度的重复经颅磁刺激治疗难治性癫癎患者,可以减少临床发作频率、延长发作潜伏期和改善脑电图异常放电。低频重复经颅磁刺激作为非药物性神经调控领域的新方法,治疗难治性癫癎安全、有效,具有较好的临床应用前景。
Objective To observe the effect of low frequency and subthreshold intensity of repetitive transcranial magnetic stimulation on refractory epilepsy. Methods Twelve patients with refractory focal epilepsy were treated with repeated transcranial magnetic stimulation. The frequency of epileptic seizures, the onset date and the seizure latency were analyzed and evaluated before and after treatment. EEG signals were collected before and after treatment, Power value (%) and spike release number. Results The frequency of seizures and the average daily attack were decreased in 12 patients (t = 2.450, P = 0.032; t = 2.797, P = 0.017) after initial treatment with low frequency repetitive transcranial magnetic stimulation. Incipient latency was prolonged in 8 patients. The relative power value (6%) of EEG decreased (t = 3.047, P = 0.011) and the relative power value of B band increased (t = -2.703, P = 0.021) The value of (α%) increased significantly (t = 3.680, P = 0.004). The number of spikes in EEG decreased (t = 2.411, P = 0.035). After re-treatment, the above indicators still showed an improvement trend. The δ% decreased, the α% increased, especially the δ% decreased 2.08 times, and the background wave improved obviously. Conclusions The treatment of patients with refractory epilepsy by repeated transcranial magnetic stimulation with low frequency and subthreshold intensity can reduce the frequency of clinical seizures, prolong the latency of seizure and improve the abnormal discharge of EEG. Low-frequency repetitive transcranial magnetic stimulation is a new method in the field of non-pharmacological neuromodulation. It is safe and effective in the treatment of refractory epilepsy and has good clinical application prospects.