薛青++戚小红++高乐虹++毛薇++魏荣++李莉萍++林华++王玉平

[摘要] 目的 探索低頻阈强度重复经颅磁刺激（rTMS）治疗注意缺陷多动障碍（ADHD）的效果。 方法 纳入2013年1月～2016年1月于首都医科大学宣武医院神经内科和儿科门诊就诊的ADHD儿童和青少年患者共20例，根据随机数字表分为真刺激组和假刺激组，每组各10例。真刺激组给予0.5 Hz 100%静息运动阈值的刺激；假刺激组给予0.5 Hz 10%静息运动阈值的刺激，刺激靶点均是右顶区，1个疗程为10 d。所有患者分别在治疗前、1个疗程治疗结束时进行视听整合持续性操作测试（IVA-CPT），并比较测试结果。 结果 与治疗前比较，真刺激组的听觉反应时间、听觉正确反应数、视觉反应时间、视觉正确反应数均在治疗结束时有显著改善（P < 0.05）；假刺激组的治疗前后比较，听觉反应时间、听觉正确反应数、视觉反应时间、视觉正确反应数均无显著改善（P > 0.05）。两组间治疗前参数比较差异无统计学意义（P > 0.05），但治疗后两组间比较，真刺激组的听觉反应时间缩短（P < 0.05），视觉反应时间缩短（P < 0.05），视觉正确反应数增加（P < 0.05），两组间听觉正确反应数差异无统计学意义（P > 0.05）。 结论 低频阈强度rTMS刺激右侧顶区皮层能改善ADHD儿童和青少年的症状。

[关键词] 重复经颅磁刺激；注意缺陷多动障碍；视听整合持续性操作测试

[中图分类号] R749.94 [文献标识码] A [文章编号] 1673-7210（2017）10（b）-0069-04

A study of rTMS treatment for ADHD patients evaluated by integrated visual and auditory continuous performance test

XUE Qing1，2 QI Xiaohong3 GAO Lehong1，2 MAO Wei1 WEI Rong3 LI Liping1，2 LIN Hua1，2 WANG Yuping1，2，3，4▲

1.Department of Neurology， Xuanwu Hospital， Capital Medical University， Beijing 100053， China； 2.Beijing Key Laboratory of Neuromodulation， Beijing 100053， China； 3.Department of Pediatrics， Xuanwu Hospital， Capital Medical University， Beijing 100053， China； 4.Beijing Institute for Brain Disorders， Beijing 100069， China

[Abstract] Objective To explore the effect of rTMS for attention deficit hyperactivity disorder （ADHD）. Methods 20 children and adolescents with ADHD treated in Neurology and Pediatrics Outpatient Clinics of Xuanwu Hospital， Capital Medical University from January 2013 to January 2016 were enrolled in the study. These patients were then divided into two groups randomly， each group had 10 cases. The active treatment group received active stimulation and the sham treatment group were given sham stimulation. The parameters of active condition was 0.5 Hz， 100% of the motor threshold， while the sham condition was 0.5 Hz， 10% of the motor threshold； the target was right parietal region； one course was 10 days. At the end of one-course treatment， integrated visual and auditory continuous performance test （IVA-CPT） was applied to assess the severity of ADHD， and the results were compared. Results In the active treatment group， compared with before treatment， auditory response time， correct auditory response， visual response time and correct visual response showed significant improvement after treatment （P < 0.05）， however， no significant improvement of any parameter was revealed in the sham treatment group （P > 0.05）. Between the two groups， significant differences were showed after treatment in auditory response time （P < 0.05）， visual response time （P < 0.05） and correct visual response （P < 0.05）， except correct auditory response （P > 0.05）， but before treatment， these parameters had no significant differences between the two groups （P > 0.05）. Conclusion Right parietal region low-frequency rTMS for ADHD children and adolescents can improve their clinical symptoms.endprint

[Key words] Repetitive transcranial magnetic stimulation； Attention deficit hyperactivity disorder； Integrated visual and auditory continuous performance test

注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）是儿童和青少年常见的精神问题[1]，影响到5%～10%的学龄儿童[2]。ADHD目前首选治疗以药物为主，但药物仅对3/4的患儿有效[3]，且部分家长拒绝药物治疗，希望接受副作用更小的治疗，如无创的神经调控疗法。经颅磁刺激（transcranial magnetic stimulation，TMS）用到人体已有30多年，是一项较为安全的物理方法，能够检测皮层功能和调控治疗大脑皮层功能障碍[4]。重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）是以治疗为主要目标的TMS方法，据报道多种脑功能疾病能用rTMS来调控皮层功能而达到治疗目的。1 ……