Machado-Joseph disease,or spinocerebellar ataxia type 3(SCA3),represents the most common autosomal dominant cerebellar ataxia worldwide.Despite its progressive and debilitating nature,disease-modifying therapies remai...Machado-Joseph disease,or spinocerebellar ataxia type 3(SCA3),represents the most common autosomal dominant cerebellar ataxia worldwide.Despite its progressive and debilitating nature,disease-modifying therapies remain elusive.Repetitive transcranial magnetic stimulation(rTMS)has emerged as a promising non-invasive intervention;however,its clinical application has been hindered by inconsistent protocols and a lack of mechanistic understanding.A recent landmark study published in Brain Stimulation by Chen et al.addressed these challenges by combining a high-dose intermittent theta-burst stimulation(iTBS)protocol with concurrent transcranial magnetic stimulation-electroencephalography(TMS-EEG).This commentary provides an in-depth analysis of their findings,highlighting the restoration of cerebello-cortical inhibition(CBI)as a key therapeutic mechanism.Furthermore,we discuss the broader implications of this work,proposing that future translational research should integrate accelerated iTBS(aiTBS)paradigms,cortical response measurements(CRM),and individualized neuro-navigation to establish a new era of precision neuromodulation for ataxia.展开更多
目的:通过Meta分析系统性评估间歇性Theta刺激改善脑卒中患者下肢运动功能、平衡功能以及日常活动能力的效果。方法:检索Cochrane Library、Scopus、PubMed、Embase、ProQuest、Web of Science、中国知网、中国生物医学、维普和万方数据...目的:通过Meta分析系统性评估间歇性Theta刺激改善脑卒中患者下肢运动功能、平衡功能以及日常活动能力的效果。方法:检索Cochrane Library、Scopus、PubMed、Embase、ProQuest、Web of Science、中国知网、中国生物医学、维普和万方数据库,选择各数据库建库至2024年11月期间间歇性Theta刺激治疗脑卒中的随机对照试验。其中,试验组接受小脑/M1区间歇性Theta刺激,对照组进行常规康复治疗。采用RevMan 5.3和Stata 16.0进行Meta分析。结果:共纳入12篇文献,444例患者。Meta分析表明,间歇性Theta刺激有助于提高脑卒中患者下肢Fugl-Meyer量表评分[WMD=2.87,95%CI(1.77,3.98),P<0.00001]、Berg平衡量表评分[WMD=5.79,95%CI(3.80,7.79),P<0.00001]以及改良Barthel指数[WMD=6.32,95%CI(4.02,8.44),P<0.00001]。亚组分析结果显示,相较于600脉冲刺激,1200脉冲刺激更有利于改善下肢Fugl-Meyer量表评分[WMD=4.31,95%CI(2.91,5.71),P<0.00001]、Berg平衡量表评分[WMD=8.12,95%CI(5.27,10.98),P<0.00001]和改良Barthel指数[WMD=8.50,95%CI(6.55,10.45),P<0.00001]。结论:间歇性Theta刺激能够提高脑卒中患者的下肢运动能力、平衡功能及日常生活能力评分。其中,1200脉冲间歇性Theta刺激在改善下肢运动能力、平衡功能和日常生活能力方面,可能具有更大益处。展开更多
目的探究低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合前庭康复训练对持续性姿势-感知性头晕(persistent postural-perceptual dizziness,PPPD)的疗效。方法通过病例对照研究分析,纳入我中心于2023年9月...目的探究低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合前庭康复训练对持续性姿势-感知性头晕(persistent postural-perceptual dizziness,PPPD)的疗效。方法通过病例对照研究分析,纳入我中心于2023年9月至2024年9月收治的48例PPPD患者为研究对象,根据患者对仪器接受程度分为对照组(n=24)和研究组(n=24)。对照组开展前庭康复训练,研究组联合低频重复经颅磁刺激治疗,对比2组治疗前、治疗后的眩晕残障量表(Dizziness Handicap Inventory,DHI)评分、前庭症状指数量表(Vestibular Symptom Index,VSI)评分、汉密尔顿抑郁量表(Hamilton Depression Rating Scale,HAMD)评分、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评分、持续性姿势-知觉头晕调查问卷(Newcastle Prolonged Dizziness Questionnaire,NPQ)评分和治疗总有效率等指标,对比治疗6周后2组的差异。结果治疗6周后,与对照组比较,研究组治疗总有效率较对照组显著升高(91.67%vs 66.67%,P=0.033),研究组较对照组DHI评分(37.85±6.46 vs 48.53±7.54,P=0.007),VSI评分(3.85±0.46 vs 5.53±1.54,P=0.002),HAMD评分(10.20±6.30 vs 15.74±7.05,P=0.006),PSQI评分(6.24±1.88 vs 8.89±2.79,P=0.003),NPQ评分(15.44±3.26 vs 20.81±9.14,P=0.009)评分更低。结论低频重复经颅磁刺激联合前庭康复训练治疗方案,可有效改善PPPD患者的头晕不适症状,提高康复有效率。展开更多
基金supported by grants from the Open Research Fund of the Zhejiang Key Laboratory of Precision Psychiatry(2025A2)the Natural Science Foundation of Zhejiang Province(LY23C090002)。
文摘Machado-Joseph disease,or spinocerebellar ataxia type 3(SCA3),represents the most common autosomal dominant cerebellar ataxia worldwide.Despite its progressive and debilitating nature,disease-modifying therapies remain elusive.Repetitive transcranial magnetic stimulation(rTMS)has emerged as a promising non-invasive intervention;however,its clinical application has been hindered by inconsistent protocols and a lack of mechanistic understanding.A recent landmark study published in Brain Stimulation by Chen et al.addressed these challenges by combining a high-dose intermittent theta-burst stimulation(iTBS)protocol with concurrent transcranial magnetic stimulation-electroencephalography(TMS-EEG).This commentary provides an in-depth analysis of their findings,highlighting the restoration of cerebello-cortical inhibition(CBI)as a key therapeutic mechanism.Furthermore,we discuss the broader implications of this work,proposing that future translational research should integrate accelerated iTBS(aiTBS)paradigms,cortical response measurements(CRM),and individualized neuro-navigation to establish a new era of precision neuromodulation for ataxia.
文摘目的探究低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)联合前庭康复训练对持续性姿势-感知性头晕(persistent postural-perceptual dizziness,PPPD)的疗效。方法通过病例对照研究分析,纳入我中心于2023年9月至2024年9月收治的48例PPPD患者为研究对象,根据患者对仪器接受程度分为对照组(n=24)和研究组(n=24)。对照组开展前庭康复训练,研究组联合低频重复经颅磁刺激治疗,对比2组治疗前、治疗后的眩晕残障量表(Dizziness Handicap Inventory,DHI)评分、前庭症状指数量表(Vestibular Symptom Index,VSI)评分、汉密尔顿抑郁量表(Hamilton Depression Rating Scale,HAMD)评分、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)评分、持续性姿势-知觉头晕调查问卷(Newcastle Prolonged Dizziness Questionnaire,NPQ)评分和治疗总有效率等指标,对比治疗6周后2组的差异。结果治疗6周后,与对照组比较,研究组治疗总有效率较对照组显著升高(91.67%vs 66.67%,P=0.033),研究组较对照组DHI评分(37.85±6.46 vs 48.53±7.54,P=0.007),VSI评分(3.85±0.46 vs 5.53±1.54,P=0.002),HAMD评分(10.20±6.30 vs 15.74±7.05,P=0.006),PSQI评分(6.24±1.88 vs 8.89±2.79,P=0.003),NPQ评分(15.44±3.26 vs 20.81±9.14,P=0.009)评分更低。结论低频重复经颅磁刺激联合前庭康复训练治疗方案,可有效改善PPPD患者的头晕不适症状,提高康复有效率。
