山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (1): 7-10.doi: 10.6040/j.issn.1673-3770.0.2020.060

• • 上一篇    下一篇

重复经颅磁刺激治疗慢性前庭综合征疗效评价

李佳威,刘晓阳,杨星昱,孙晓明,李曦丹   

  1. 大连市第三人民医院 神经电生理科, 辽宁 大连 116000
  • 发布日期:2021-02-01
  • 通讯作者: 刘晓阳. E-mail:hanweiqi1981@163.com
  • 基金资助:
    辽宁省科学计划指导项目(20180550412)

Effect of repetitive transcranial magnetic stimulation on chronic vestibular syndrome

LI Jiawei, LIU Xiaoyang, YANG Xingyu, SUN Xiaoming, LI Xidan   

  1. Department of Electrophysiology Science, Dalian Third People's Hospital, Dalian 116000, Liaoning, China
  • Published:2021-02-01

摘要: 目的 探讨重复经颅磁刺激(rTMS)治疗慢性前庭综合征(CVS)的疗效。 方法 慢性前庭综合征(CVS)患者60例,随机数字法分为对照组和治疗组各30例,两组均进行垂直方向和水平方向的平稳跟踪眼动练习,治疗组另加以rTMS治疗4周。以治疗前后两组患者的头晕评价量表(DHI)评分、冷热试验单/双侧半规管反应减退(UW)值为指标,比较分析两组患者治疗前后两项指标的恢复情况。 结果 治疗前治疗组与对照组DHI评分差异无统计学意义(P=0.872),冷热试验UW值差异无统计学意义(P=0.079),治疗后两组DHI评分减低,差异具有统计学意义(P<0.01),冷热试验UW值减低,差异具有统计学意义(P=0.02),2组治疗前后的DHI评分及UW值差异具有统计学意义(P<0.01),治疗组治疗前后DHI评分差值为39.40分,对照组治疗前后DHI评分差值为25.67分,治疗组治疗前后UW差值为16.03,对照组治疗前后UW差值为12.03。 结论 rTMS治疗CVS疗效明显,有益于促进前庭代偿建立。

关键词: 重复经颅磁刺激, 前庭综合征, 前庭康复, 冷热试验, 头晕评价量表

Abstract: Objective This study aimed to investigate the effect of repetitive transcranial magnetic stimulation(rTMS)on chronic vestibular syndrome(CVS). Methods Sixty patients with chronic vestibular syndrome(CVS)were randomly divided into a control group and a treatment group, each with 30 patients. Patients in both groups performed eye-tracking exercises in the vertical and horizontal directions. The treatment group was treated with rTMS for 4 weeks. The dizziness evaluation scale(DHI)score and unilateral/bilateral semicircular canal response(UW)values of the two groups before and after treatment were compared and analyzed. Results There was no significant difference in DHI score between the treatment group and the control group before treatment(P=0.872)while there was no significant difference in UW value between hot and cold test(P=0.079). However, after treatment, the difference of DHI score was statistically significant between the two groups(P<0.01)and the UW value of cold and hot test decreased, and the difference was statistically significant(P=0.02), There were significant differences in DHI score and UW value between the two groups before and after treatment(P<0.01), The difference in DHI score before and after treatment in the treatment group was 39.40 points, while the difference in DHI score before and after treatment in the control group was 25.67 points, the difference in UW score before and after treatment in the treatment group was 16.03, and the difference in UW score before and after treatment in the control group was 12.03. Conclusion rTMS is effective in the treatment of CVS and is good for promoting the establishment of vestibular compensation.

Key words: Repetitive transcranial magnetic stimulation, Chronic vestibular syndrome, Vestibular rehabilitation, Caloric test, Dizziness evaluation scale

中图分类号: 

  • R512
[1] Alexandre R. Bisdorff, Jeffrey P.Staab, David E. Newman-Toker. Overview of the international classification of vestibular disorders[J]. Neurol Clin, 2015, 33(3): 541-550. doi: 10.1016/j.ncl.2015.04.010.
[2] Strupp M, Mandalà M, López-Escámez JA. Peripheral vestibular disorders[J]. Curr Opin Neurol, 2019, 32(1): 165-173. doi:10.1097/wco.0000000000000649.
[3] Strupp M, Brandt T. Peripheral vestibular disorders[J]. Curr Opin Neurol, 2013, 26(1): 81-89. doi:10.1097/wco.0b013e32835c5fd4.
[4] Guo F, Lou JC, Han XH, et al. Repetitive transcranial magnetic stimulation ameliorates cognitive impairment by enhancing neurogenesis and suppressing apoptosis in the Hippocampus in rats with ischemic stroke[J]. Front Physiol, 2017, 8: 559. doi:10.3389/fphys.2017.00559.
[5] Luo J, Zheng HQ, Zhang LY, et al. High-frequency repetitive transcranial magnetic stimulation(rTMS)improves functional recovery by enhancing neurogenesis and activating BDNF/TrkB signaling in ischemic rats[J]. Int J Mol Sci, 2017, 18(2): 455. doi:10.3390/ijms18020455.
[6] 殷稚飞, 程清, 秦义婷, 等. 小脑经颅磁刺激调控脑高级功能的研究进展[J]. 中华物理医学与康复杂志, 2018, 40(10): 791-794. doi:10.3760/cma.j.issn.0254-1424.2018.10.019.
[7] 鞠奕, 田军茹. 慢性前庭综合征的临床诊断及治疗[J]. 中华内科杂志, 2016, 55(10): 753-754. doi:10.3760/cma.j.issn.0578-1426.2016.10.005.
[8] World Health Organization. The international classification of diseases, ICD-11 beta draft[S/OL]. [2015-01-30].
[9] 中国医药教育协会眩晕专业委员会, 中国康复医学会眩晕与康复专业委员会, 中西医结合学会眩晕专业委员会, 等. 前庭功能检查专家共识(一)(2019)[J]. 中华耳科学杂志, 2019, 17(1): 117-123. doi:10.3969/j.issn.1672-2922.2019.01.020.
[10] 于立身. 前庭功能检查技术[M]. 西安: 第四军医大学出版社, 2013.
[11] Jacobson GP, Newman CW. The development of the dizziness handicap inventory[J]. Arch Otolaryngol-Head Neck Surg, 1990, 116(4): 424-427. doi:10.1001/archotol.1990.01870040046011.
[12] Han BI, Song HS, Kim JS. Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises[J]. J Clin Neurol, 2011, 7(4): 184. doi:10.3988/jcn.2011.7.4.184.
[13] Hall CD, Herdman SJ, Whitney SL, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline: from the American physical therapy association neurology section[J]. J Neurol Phys Ther, 2016, 40(2): 124-155. doi:10.1097/npt.0000000000000120.
[14] Yuri Agrawal, John P Carey, Charles C Della Santina, et a1. Disorders of balance and vestibular function in US adults: data from the national health and nutrition examination survey, 2001-2004[J]. Arch Intern Med, 2009, 169(10): 938-944. doi: 10.1001/archinternmed.2009.66.
[15] Horak FB, Jones-Rycewicz C, Black FO, et al. Effects of vestibular rehabilitation on dizziness and imbalance[J]. Otolaryngol Head Neck Surg, 1992, 106(2): 175-180. doi:10.1177/019459989210600220.
[16] Hall CD, Herdman SJ, Whitney SL, et a1. Vestibular rehabilitation for peripheral vestibular hypofunction:an evidence-based clinical practice guideline[J]. J Neurol Phys Ther, 2016, 40(2): 124-155. doi: 10.1097/NPT.0000000000000120.
[17] 刘波. 前庭功能低下患者康复治疗流程管理的循证医学证据进展[J]. 中国耳鼻咽喉头颈外科, 2019, 26(5): 272-276. doi:10.16066/j.1672-7002.2019.05.010.
[18] 王冰, 李玮, 李六一, 等. 低频经颅磁刺激治疗阵发性位置性眩晕患者成功手法复位后残余头晕的疗效观察[J]. 中华物理医学与康复杂志, 2017, 39(4): 286-289. doi: 10.3760/cma.j.issn.0254-1424.2017.04.011.
[19] Colnaghi S, Honeine JL, Sozzi S, et al. Body sway increases after functional inactivation of the cerebellar vermis by cTBS[J]. Cerebellum, 2017, 16(1): 1-14. Doi: 10.1007/s12311-015-0758-5.
[20] Mancic B, Stevanovic I, Ilic TV, et al. Transcranial Theta-burst stimulation alters GLT-1 and vGluT1 expression in rat cerebellar cortex[J]. Neurochem Int, 2016, 100: 120-127. doi:10.1016/j.neuint.2016.09.009.
[21] 林鹏, 董红, 陈太生, 等. 冷热试验优势偏向对前庭动态代偿评估价值的探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(8): 631-635. doi:10.3760/cma.j.issn.1673-0860.2009.08.006.
[1] 杨军, 郑贵亮. 外周前庭疾病的诊断和治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 1-6.
[2] 梁敏, 吴悔, 陈建勇, 张勤, 李姝娜, 郑贵亮, 何景春, 陈向平, 杨军. 前庭诱发肌源性电位预测突聋患者疗效的临床价值[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 27-32.
[3] 吴悔, 梁敏, 陈建勇, 张勤, 李姝娜, 郑贵亮, 何景春, 陈向平, 杨军. 全聋型突发性耳聋患者的预后与前庭症状及前庭功能关系的回顾性分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 33-38.
[4] 邓巧媚,王巍,温超,刘强,毛翔,韩曦,李姗姗,陈太生,徐开旭,林鹏. 头晕眩晕与眼震强度的关系研究[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 56-60.
[5] 郑贵亮, 刘凌峰, 陈建勇, 张青, 杨军. 基于移动互联网的前庭康复训练指导平台的开发与应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(5): 78-81.
[6] 丁剑,刘艺鸣. 前庭康复对老年良性阵发性位置性眩晕患者后遗头晕的疗效[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 64-68.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[3] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[4] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
[5] 楼正才 . 掌拳击伤鼓膜损伤机制及临床特点分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 188 -188 .
[6] 刘 艳,刘新义,王金平,李大健 . 后鼓室解剖结构测量观察及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 218 -221 .
[7] 赵 敏,王守森,甄泽年,陈贤明,王茂鑫 . 鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 244 -245 .
[8] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[9] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[10] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .