| Purpose: Parkinson’s disease(PD)is a neurodegenerative disease that affects motor and cognitive abilities.The main pathological changes are degeneration,necrosis and decrease of dopaminergic neurons in substantia nigra,which leads to the degeneration of multiple nerve conduction circuits in the brain,especially in the substantia nigra-striatum and frontal lobe-striatum pathways.Repetitive transcranial magnetic stimulation(rTMS)is an effective neuromodulation therapy.Different stimulation targets and patterns have different effection in PD motor ability and cognitive impairment.The goal of this study was to investigate whether different high-frequency repetitive transcranial magnetic stimulation(rTMS)on the bilateral dorsolateral prefrontal cortex(DLPFC)can improve the walking,balance ability as well as cognitive impairment in PD patients.Methods: The 44 right-handed PD patients enrolled into this study which came from Weihai Central Hospital affiliated to Qingdao University from October 2019 to October2020.PD patients were divided into rTMS group and sham stimulation group randomly,with 22 cases in each group.The rTMS group received different high-frequency rTMS stimulation on bilateral DLPFC(1600 pulses;left 20 Hz,right 10Hz;80%MT)for 10 days(5 days a week).The sham group received the sham rTMS stimulation.To observe the differences in walking and balance ability as well as cognitive function in the same and different groups of PD patients pre and post-treatment.Parkinson’s Disease Score Scale III(UPDRS-III),Bery balance scale(BBS),Activity Balance Confidence Scale(ABC),Simple Mental State Scale(MMSE),Montreal Cognitive Assessment(Mo CA),improved TUG experiment and other evaluations were performed,the average time used in the improved TUG experiment(TUGT),turning time(TT),turning steps(TS)and the scores of related scales was recorded.Results: There was no statistically significant difference between the two groups(p>0.05)in gender,age,disease duration,height,weight,Hoehn-Yahr scale,years of education,Mo CA score,equivalent dose of levodopa,FOG rate and UPDRS III.1.There were statistical differences in movement parameters between pre-treatment and post-treatment in the rTMS group,and the TUGT,TS,UPDRS-III between pre-treatment and post-treatment in the sham group(P<0.05).After treatment,only TUGT(19.87(18.81,21.13)vs 23.70(20.04,26.44),P=0.01),TT(6.32(5.33,6.78)vs6.92(6.02,8.26),P=0.04)in the rTMS group is lower than that in the sham group(p<0.05).2.There were statistically significant differences in BBS and ABC scores between pre-treatment and post-treatment in the rTMS group(P<0.05),while there was no corresponding change in the sham group(P>0.05).The scores of BBS(46.86±2.25vs44.00±2.18,P=0.00)and ABC(70.68±4.84vs67.59±4.28,P=0.03)in the rTMS group after treatment were significantly higher than those in the sham group(p<0.05).3.There was statistically significant in the scores of MMSE and Mo CA between pre-treatment and post-treatment in the rTMS group(P<0.05),while the scores of MMSE and Mo CA in the sham group had no similar changes(P>0.05).After treatment,the MMSE(25.73±1.27vs24.41±1.50,P=0.00),Mo CA(24.00(22.75,25.00)vs 23.00(22.00,24.00),P=0.04)scores in the rTMS group were significantly higher than those in the sham group(P<0.05).Conclusion:1.Different high frequency rTMS on bilateral DLPFC can improve walking,balance and cognitive function of PD patients.2.The pattern of rTMS with multiple targets and different frequencies may be an effective method,which may exert a variety of therapeutic effects,could improve the motor and non-motor symptoms of PD. |
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