Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector79610.54101/ACEN.2021.4.1Original articlesОригинальные статьиResearch ArticleRepetitive transcranial magnetic stimulation in the treatment of mild cognitive impairment due to cerebral small vessel diseaseРитмическая транскраниальная магнитная стимуляция в терапии умеренных когнитивных расстройств при церебральной микроангиопатииhttps://orcid.org/0000-0002-9267-8315LagodaDmitry Yu.ЛагодаДмитрий Юрьевич
Russian Federation

junior researcher, Department of neurorehabilitation and physiotherapy

м.н.с. отд. нейрореабилитации и физиотерапии

lagoda.d@neurology.ruhttps://orcid.org/0000-0001-9929-2725DobryninaLarisa A.ДобрынинаЛариса Анатольевна
Russian Federation

D. Sci. (Med.), Head, 3rd Neurological department

д.м.н., рук. 3-го неврологического отделения

lagoda.d@neurology.ruhttps://orcid.org/0000-0003-3956-6362SuponevaNatalya A.СупоневаНаталья Александровна
Russian Federation

D. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences, principal researcher, Department of neurorehabilitation and physiotherapy

д.м.н., проф., член-корреспондент РАН, г.н.с. отд. нейрореабилитации и физиотерапии

lagoda.d@neurology.ruhttps://orcid.org/0000-0003-0716-3737BakulinIlya S.БакулинИлья Сергеевич
Russian Federation

Cand. Sci. (Med.), researcher, Department of neurorehabilitation and physiotherapy

к.м.н., н.с. отд. нейрореабилитации и физиотерапии

lagoda.d@neurology.ruhttps://orcid.org/0000-0003-1841-1177PoydashevaAlexandra G.ПойдашеваАлександра Георгиевна
Russian Federation

junior researcher, neurologist, Department of neurorehabilitation and physiotherapy

м.н.с., врач-невролог отд. нейрореабилитации и физиотерапии

lagoda.d@neurology.ruhttps://orcid.org/0000-0002-4231-3895TsypushtanovaMariia M.ЦыпуштановаМария Михайловна
Russian Federation

postgraduate student, 3rd Neurological department

аспирант 3-го неврологического отделения

lagoda.d@neurology.ruhttps://orcid.org/0000-0001-7491-7215KadykovAlbert S.КадыковАльберт Серафимович
Russian Federation

D. Sci. (Med.), Professor, senior researcher, 3rd Neurological department

д.м.н., проф., г.н.с. 3-го неврологического отделения

lagoda.d@neurology.ruhttps://orcid.org/0000-0002-6338-0392PiradovMikhail A.ПирадовМихаил Александрович
Russian Federation

D. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Director

д.м.н., проф., академик РАН, директор

lagoda.d@neurology.ruResearch Center of NeurologyФГБНУ «Научный центр неврологии»231220211545142212202122122021Copyright ©; 2021, Lagoda D.Y., Dobrynina L.A., Suponeva N.A., Bakulin I.S., Poydasheva A.G., Tsypushtanova M.M., Kadykov A.S., Piradov M.A.Copyright ©; 2021, Лагода Д.Ю., Добрынина Л.А., Супонева Н.А., Бакулин И.С., Пойдашева А.Г., Цыпуштанова М.М., Кадыков А.С., Пирадов М.А.2021Lagoda D.Y., Dobrynina L.A., Suponeva N.A., Bakulin I.S., Poydasheva A.G., Tsypushtanova M.M., Kadykov A.S., Piradov M.A.Лагода Д.Ю., Добрынина Л.А., Супонева Н.А., Бакулин И.С., Пойдашева А.Г., Цыпуштанова М.М., Кадыков А.С., Пирадов М.А.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/796

Introduction. Mild cognitive impairment (MCI) negatively affects patients’ quality of life and is a risk factor for dementia. One of the main causes of MCI is cerebral small vessel disease (CSVD). The previously established link between decreased activity in the supplementary motor area (SMA) and cognitive impairment in patients with CSVD makes it possible to consider repetitive transcranial magnetic stimulation (rTMS) of the SMA with functional magnetic resonance imaging (fMRI)-assisted positioning as a promising method for treating MCI caused by CSVD.

The aim of the study was to evaluate the efficacy and tolerability of fMRI-guided rTMS of the SMA in patients with MCI caused by CSVD.

Materials and methods. Twenty patients were randomly assigned to the intervention (SMA stimulation; n = 10) and the control (vertex stimulation; n = 10) groups. All patients underwent 10 sessions of high-frequency rTMS. The MoCA scale, trail making test, Tower of London test, and copying and delayed recall in the Rey–Osterrieth complex figure test were used to assess treatment effect. Testing was conducted before, immediately after and 3 months post rTMS.

Results. The intervention group demonstrated a significant improvement in the MoCA, the Tower of London test and delayed recall in the Rey–Osterrieth complex figure test immediately after rTMS. Statistically significant improvement in the MoCA and the Tower of London test results was maintained after 3 months. No statistically significant improvements were found in the control group. Groups were comparable in the incidence of headache during and in the 24-hour period after the stimulation session, and in unpleasant sensations during the session.

Conclusion. fMRI-guided rTMS of the SMA is an effective and promising treatment method for MCI caused by CSVD, with effects lasting three or more months, and good tolerability.

Введение. Умеренные когнитивные расстройства (УКР) негативно влияют на качество жизни пациентов и являются фактором риска развития деменции. Одной из основных причин УКР является церебральная микроангиопатия (ЦМА). Ранее установленная связь снижения функциональной активности дополнительной моторной области (ДМО) в развитии когнитивных нарушений у пациентов с ЦМА позволяет рассматривать ритмическую транскраниальную магнитную стимуляцию (рТМС) ДМО под контролем функциональной магнитно-резонансной томографии (фМРТ) в качестве перспективного метода терапии УКР при ЦМА.

Цель исследования — оценить эффективность и переносимость фМРТ-направленной рТМС ДМО у пациентов с УКР при ЦМА.

Материалы и методы. 20 пациентов случайным образом были распределены в активную (стимуляция ДМО; n = 10) и контрольную (стимуляция вертекса; n = 10) группы. Все пациенты получали 10 сессий высокочастотной рТМС. Для оценки эффектов использовались шкала МоСА, тест построения пути, «Башня Лондона», копирование и отсроченное воспроизведение комплексной фигуры Рея–Остеррица. Тестирование проводили до, сразу после и через 3 мес после рТМС.

Результаты. В активной группе сразу после рТМС статистически значимо улучшались показатели тестов МоСА, «Башня Лондона», отсроченное воспроизведение комплексной фигуры Рея–Остеррица. Через 3 мес сохранялось статистически значимое улучшение показателей МоСА и «Башня Лондона». В контрольной группе статистически значимого улучшения не было. Группы были сопоставимы по частоте появления головной боли во время и в течение 24 после сессии, неприятных ощущений во время сессии.

Заключение. фМРТ-направленная рТМС ДМО — эффективный и перспективный метод терапии УКР при ЦМА с продолжительностью эффекта от 3 мес и благоприятным профилем переносимости.

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