O15 Long term follow-up study with non-invasive brain stimulation (NBS) (rTMS and TDCS) in parkinson’s disease. strong age dependency in the effect of NBS

摘要

Parkinson’s disease (PD) produces progressive declines throughout the patient’s life. Its development is not linear and can not be effectively influenced by drugs. Repetitive transcranial magnetic stimulation (rTMS) may slower the progression of the disease compared with dopa substitution (Málly, 2004). The long term mind modification effect of regularly repeated rTMS and tDCS is not known. The predictors for the treatment with non-invasive brain stimulation are not known. In our study we followed 30 patients with PD for 3.5 years. Patients were stimulated with rTMS (1 Hz, low intensity for 7 days), which was repeated every half year for one and half year. After stimulation with 1 Hz the transcranial direct current stimulation (tDCS) over both sides of cerebellum was introduced for the next 2 years as add on therapy to rTMS. Motor disability was assessed by UPDRS and the executive function was measured by Trail Making Test and dual tests. There was a highly significant difference in the deterioration of patients in motor disability ?65 yrs and 65 yrs ( p 0.001). Motor disability ?65 yrs assessed by UPDRS (onset of the treatment: 19.2 ± 12.4, the end of rTMS: 17.0 ± 7.3, the end of tDCS for 2 years: 17.3 ± 8.8) progression rate 0.13421. The progression above 65 yrs onset of treatment (18.2 ± 7.3, the end of rTMS: 23.2 ± 12.3, the end of tDCS for 2 years: 27.7 ± 13.0, progression rate: 0.23217). The Trail Making test B-A was significantly worse in PD over 65 yrs compared to age match controls and patients with PD under 65 yrs (PD ?65 yrs: 30.3 ± 8.3 s, PD 65 yrs: 62.2 ± 8.1 p 0.0001). During the repeated treatment with tDCS the patient 65 yrs showed a significant improvement (onset of tDCS: 59.1 ± 12.2 s, the end of tDCS: 33.6 ± 8.1 p 0.0001). Dual tests (counting back by 3 and 7 during walking) showed a similar improvement under regularly repeated tDCS stimulation during 2 years. The gender and duration of the disease did not influence on the development of the disease as strongly as age. The motor ability in PD can be maintained in the same level ?65 yrs with rTMS (1 Hz) for the followed 3.5 years. Patients above 65 yrs deteriorated highly significantly compared with the group 65 yrs. The cognitive function was influenced by tDCS in the group 65 yrs where the results were significantly deteriorated compared with age match controls and patients with ?65 yrs. The age is the main predictors for the effect of rTMS with 1 Hz. The progression rate was lower in both former groups than in our earlier study with dopa substitution only. ]]>