Effect of transcranial pulsed electromagnetic fields (T-PEMF) on functional rate of force development and movement speed in persons with Parkinson’s disease: A randomized clinical trial

BackgroundParkinson’s disease is caused by dopaminergic neurodegeneration resulting in motor impairments as slow movement speed and impaired balance and coordination. Pulsed electromagnetic fields are suggested to have neuroprotective effects, and could alleviate symptoms.ObjectiveTo study 1) effects of 8-week daily transcranial pulsed electromagnetic field treatment on functional rate of force development and movement speed during two motor tasks with different levels of complexity, 2) if treatment effects depend on motor performance at baseline.MethodsNinety-seven persons with Parkinson’s disease were randomized to active transcranial pulsed electromagnetic field (squared bipolar 3 ms pulses, 50 Hz) or placebo treatment with homebased treatment 30 min/day for 8 weeks. Functional rate of force development and completion time of a sit-to-stand and a dynamic postural balance task were assessed pre and post intervention. Participants were sub-grouped in high- and low-performers according to their baseline motor performance level. Repeated measure ANOVAs were used.ResultsActive treatment tended to improve rate of force development during chair rise more than placebo (P = 0.064). High-performers receiving active treatment improved rate of force development during chair rise more than high-performers receiving placebo treatment (P = 0.049, active/placebo: 11.9±1.1 to 12.5±1.9 BW/s ≈ 5% / 12.4±1.3 to 12.2±1.3 BW/s, no change). No other between-treatment-group or between-treatment-subgroup differences were found. Data on rate of force development of the dynamic balance task and completion times of both motor tasks improved but did not allow for between-treatment differentiation.ConclusionTreatment with transcranial pulsed electromagnetic fields was superior to placebo regarding functional rate of force development during chair rise among high-performers. Active treatment tended to increase functional rate of force development while placebo did not. Our results suggest that mildly affected persons with Parkinson’s disease have a larger potential for neural rehabilitation than more severely affected persons and indicate that early treatment initiation may be beneficial.

【背景】帕金森病（Parkinson’s disease）由多巴胺能神经元变性引发，可导致运动功能障碍，表现为运动速度减慢、平衡与协调能力受损。现有研究提示脉冲电磁场具有神经保护作用，能够缓解相关临床症状。

研究目的：本研究旨在探讨两个核心问题：1）为期8周的每日经颅脉冲电磁场（transcranial pulsed electromagnetic field）治疗，在两项复杂程度不同的运动任务中，对功能性肌力发展速率（rate of force development）及运动速度的影响；2）治疗效果是否与受试者基线运动表现水平相关。

研究方法：本研究共纳入97名帕金森病患者，将其随机分为主动经颅脉冲电磁场治疗组与安慰剂对照组，两组均采用居家治疗方案，每日治疗30分钟，持续8周。主动治疗采用方形双极3ms脉冲、频率50Hz的经颅脉冲电磁场。分别于干预前后，对受试者的功能性肌力发展速率，以及完成坐站（sit-to-stand）任务与动态姿势平衡任务的耗时进行评估。根据受试者基线运动表现水平，将其划分为高表现亚组与低表现亚组。统计分析采用重复测量方差分析（repeated measure ANOVAs）。

研究结果：主动治疗组在坐椅起身过程中的肌力发展速率呈现出优于安慰剂组的改善趋势（P=0.064）。其中高表现亚组中，接受主动治疗的受试者其坐椅起身时的肌力发展速率改善程度显著优于安慰剂组高表现亚组（P=0.049；主动组：11.9±1.1 升至12.5±1.9 BW/s，增幅约5%；安慰剂组：12.4±1.3 至12.2±1.3 BW/s，无明显变化）。其余治疗组间、治疗亚组间未观察到其他显著差异。动态平衡任务的肌力发展速率数据，以及两项运动任务的完成耗时均有所改善，但无法区分两组治疗效果的差异。

结论：经颅脉冲电磁场治疗在高表现亚组帕金森病患者的坐椅起身功能性肌力发展速率方面，效果优于安慰剂。主动治疗可提升功能性肌力发展速率，而安慰剂组未出现此类改善。本研究结果提示，轻度受损的帕金森病患者相较于重度受损患者，具备更大的神经康复潜力，同时表明早期启动治疗或可带来临床获益。