| Objective: To observe the clinical efficacy of high frequency repetitive transcranial magnetic stimulation (rTMS) combined with selegiline hydrochloride in the treatment of Parkinson’s disease (PD) with excessive daytime sleepiness (EDS) sleep disorder and its correlation with diffusion tensor imaging (TDI). Methods: A total of PD 88 patients with EDS treated in our hospital from August 2017 to July 2020 were selected as the research objects. They were randomly divided into control group and observation group. Both groups were treated with dynamically adjusted basic drugs combined with selegilan hydrochloride, and the control group was treated with pseudomagnetic stimulation. The observation group was treated with real rTMS. The two groups were intervened for 12 weeks. The changes of fractional anisotropy (FA) of DTI before and after intervention were observed in the two groups (the areas of interest contained substantia nigra, red nucleus, putamen, mesencephalic tegmentum and pontine tegmentum). The total dose of left DOPA (LD), Epworth Sleepiness Scale (ESS), 39 item questionnaire (PDQ-39) and Unified Parkinson’s Disease Rating Scale (UPDRS) were observed before intervention, and 6 weeks, 12 weeks and 3 months after treatment. Results: The total dose of LD in the observation group at 6th week, 12th week and 3rd month after the intervention was lower than that before treatment and the control group (P<0.05); Grouping and time had interactive effects on dose (F = 18.459, P=0.015). In terms of DTI indexes, the FA of midbrain tegmentum and pontine tegmentum in the observation group after intervention was higher than that in the control gro-up, and the difference was statistically significant (P<0.05). The ESS score in the observation group was lower than that in the control group at 3rd week, 6th week, 12th week and 3rd month after the intervention; Grouping and time had interaction effects on ESS score (f interaction = 8.466, P=0.028). The PDQ-39 score in the observation group was lower than that in the control group at 3rd week, 6th week, 12th week and 3rd month after the intervention (P<0.05); Grouping and time had interaction effects on PDQ-39 (f interaction = 11.474, P=0.021). The scores of UPDRS, UPDRS Ⅰ, UPDRS Ⅱ and UPDRS Ⅳ in the observation group were significantly lower than those in the control group at 6th week, 12th week and 3rd month after the intervention (P=0.031, 0.021, 0.039). Correlation analysis showed that the decrease of LD total dose, ESS score, PDQ-39 score and UPDRS (Ⅰ and Ⅱ) score in the observation group after treatment was negatively correlated with the increase of FA value of midbrain tegmental. The decrease of total LD dose and UPDRS I score was negatively correlated with the increase of pontine tegmental FA value (P<0.05). Conclusion:The rTMS combined with selegilan hydrochloride has significant short-term and long-term effects on PD with EDS; The effective improvement of patients’ quality of life and related non motor symptoms is considered to be related to the increase of FA in pontine tegmentum and midbrain tegmentum by DTI. |
