| Objective: To investigate the effect of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with dynamic and static balance training on frozen gait in patients with vascular Parkinson’s syndrome (VP), and to analyze its potential neural mechanism by diffusion tensor imaging (DTI). Methods: A total of 187 patients with VP freezing gait were randomly divided into observation group (n=93) and control group (n=94). The control group was given dynamic and static balance instrument training and sham HF-rTMS stimulation on the basis of routine rehabilitation training. The observation group was subjected to HF-rTMS in combination with dynamic and static balance instrument training on the basis of routine rehabilitation training. The gait, balance function, unified Parkinson’s disease rating scale (UPDRS) and DTI parameters of VP patients were observed before and 4 weeks after treatment. Results: After 4 weeks of treatment, the step frequency of the two groups decreased (P<0.01), and that in the observation group was lower than in the control group (P<0.01). The step speed, dominant side and non-dominant side step length of the two groups increased (P<0.01), and those in the observation group were increased as compared with those in the control group (P<0.01). After 4 weeks of treatment, the FOG scores of the two groups decreased (P<0.05), and that in the observation group was lower than in the control group (P<0.05). For balance function, after 4 weeks of treatment, the scores of Berg balance scale (BBS), trunk injury scale (TIS) and postural stability limit (LOS) in the two groups were significantly increased (P<0.05,0.01), and the score of timed up and go test (TUGT) was decreased (P<0.05, 0.01). However, the BBS score, TIS score and LOS in the observation group were higher than those in the control group (P<0.05), and the TUGT score was lower than that in the control group (P<0.05). After 4 weeks of treatment, UPDRS Ⅱ, Ⅲ and 39 Parkinson’s disease quality of life questionnaire (PDQ-39) scores were significantly decreased (P＜0.01), and those in the observation group were reduced as compared with the control group (P<0.01). After 4 weeks of treatment, the fractional anisotropy (FA) values of putamen, red nucleus, substantia nigra, midbrain tegmentum and thalamus in the two groups increased (P<0.05, 0.01), and those in the observation group were higher than in the control group (P<0.05, 0.01). There was no significant correlation between the FA values of putamen, red nucleus, globus pallidus and thalamus in DTI after treatment and UPDRS Ⅱ and Ⅲ after treatment. The FA values of substantia nigra and tegmental area were negatively correlated with UPDRS Ⅱ and Ⅲ scores (r=-0.563, -0.620, -0.723, -0.754, P<0.01). Conclusion: HF-rTMS combined with dynamic and static balance training can significantly improve the postural balance function of patients with early VP freezing gait and improve the freezing gait. The mechanism may be achieved by affecting the integrity of nerve fibers in the substantia nigra, midbrain tegmental area and other areas. |
