不同频率rTMS治疗脑梗死继发癫痫的效果对比

doi:10.19854/j.cnki.1008-2425.2025.04.0005

摘要/Abstract

摘要： 目的探讨不同频率重复经颅磁刺激(rTMS)治疗脑梗死继发癫痫中效果。方法选取2022年6月~2024年1月于我院就诊的脑梗死继发癫痫患者122例,以随机数字表法分为A组(n=61)、B组(n=61),均给予常规药物治疗及小组认知训练,A组联合1.0HZ rTMS,B组联合0.5HZ rTMS,比较两组疗效、康复指标[癫痫持续状态严重程度量表(STESS)评分、癫痫每月发作次数、癫痫每次持续时间]、神经功能[改良Rankin量表(mRS)]、认知功能[简易精神状态评价量表(MMSE)]、氧化-抗氧化指标[血清丙二醛(MDA)、总抗氧化能力(TAC)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)]、神经损伤相关因子[胶质酸性纤维蛋白(GFAP)、S-100β、神经元特异性烯醇化酶(NSE)]、炎症相关指标[海马核转录因子κB(NF-κB)、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]及安全性。结果 A组总有效率93.44%(57/61)明显高于B组80.33%(49/61)(P＜0.05);治疗后A组STESS评分、mRS评分、癫痫每月发作次数、癫痫持续时间低于B组,MMSE评分高于B组(P＜0.05);治疗后A组TAC、SOD、GSH-Px高于B组,MDA、GFAP、IL-1β、S-100β、NSE、NF-κB、TNF-α低于B组(P＜0.05);两组均未发生不良反应、未出现肝肾功能、血常规异常。结论相比0.50Hz低频rTMS,1.0Hz低频rTMS治疗脑梗死继发癫痫效果更佳,可通过抑制机体氧化应激、炎症反应更好地减轻癫痫症状,改善神经损伤、认知障碍,且安全性高。

关键词: 脑梗死, 继发癫痫, 重复经颅磁刺激, 频率, 神经功能

Abstract: Objective To investigate the effect of different frequency repetitive transcranial magnetic stimulation (rTMS) on secondary epilepsy after cerebral infarction. Methods A total of 122 patients with epilepsy secondary to cerebral infarction who were treated in our hospital from June 2022 to January 2024 were selected and randomly divided into group A (n=61) and group B(n=61) using a random number table method.Both groups were given conventional drug therapy and group cognitive training.Group A received 1.0 Hz rTMS,while group B received 0.5 Hz rTMS.The efficacy,rehabilitation indicators [Seizure Status Epilepsy Severity Scale (STESS) score,monthly seizure frequency,and duration of each seizure],neurological function [Modified Rankin Scale (mRS)],cognitive function [Mini-Mental State Examination (MMSE)],oxidative-antioxidant indicators [serum malondialdehyde (MDA),total antioxidant capacity (TAC),superoxide dismutase (SOD),glutathione peroxidase (GSH-Px)],factors related to neurological injury [glial fibrillary acidic protein (GFAP),S-100β,neuron-specific enolase (NSE)],indicators related to inflammation [hippocampal nuclear transcription factor κB (NF-κB),interleukin-1β (IL-1β),tumor necrosis factor-α (TNF-α)],and safety were compared between the two groups. Results The total effective rate of group A was 93.44% (57/61) higher than that of group B (80.33% (49/61) (P＜0.05).After treatment,STESS score,mRS Score,monthly seizure frequency and duration of epilepsy in group A were lower than those in group B,and MMSE score was higher than those in group B (P＜0.05).After treatment,TAC,SOD and GSH-Px in group A were higher than those in group B,MDA,GFAP,IL-1β,S-100β,NSE,NF-κB and TNF-α were lower than those in group B (P＜0.05).Neither group experienced adverse reactions,abnormalities in liver and kidney function,or blood routine tests. Conclusion Compared with 0.50 Hz low-frequency rTMS,1.0 Hz low-frequency rTMS has better therapeutic effects on secondary epilepsy after cerebral infarction,which can better alleviate epilepsy symptoms by inhibiting oxidative stress and inflammatory response,improve neurological damage and cognitive impairment,and is highly safe.

Key words: Cerebral infarction, Secondary epilepsy, Repetitive transcranial magnetic stimulation, Frequency, Neurological function

中图分类号:

R742.1

行超然, 宁良霞, 乔波, 邹映慧, 原永康. 不同频率rTMS治疗脑梗死继发癫痫的效果对比[J]. 立体定向和功能性神经外科杂志, 2025, 38(4): 220-226.

Xing Chaoran, Ning Liangxia, Qiao Bo, Zou Yinghui, Yuan Yongkang. Comparison of the effects of different frequency rTMS treatments on secondary epilepsy after cerebral infarction[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(4): 220-226.

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