Koski Lisa, Mernar Thomas J, Dobkin Bruce H
Ahmanson-Lovelace Brain Mapping Center, Neuropsychiatric Institute and Department of Neurology, University of California at Los Angeles, USA.
Neurorehabil Neural Repair. 2004 Dec;18(4):230-49. doi: 10.1177/1545968304269210.
The goal of this study was to determine whether transcranial magnetic stimulation (TMS) measures of the corticomotor pathways might reflect and predict functional improvements during rehabilitation of a hemiparetic upper extremity. Ten patients with variable levels of functional impairment in upper extremity use were enrolled at least 3 months after a stroke. TMS was used to obtain serial measures of motor thresholds and motor-evoked potential (MEP) size for a muscle from both hands before and after each session of an intervention aimed at improving functional motor control. Functional ability and cortical map area and volume were measured before each therapy session. At intake, all TMS measures from the affected side were impaired compared with the unaffected side but they did not reliably predict the level of functional improvement. Motor thresholds decreased, whereas MEP amplitude and map size increased with treatment. The amount of change in affected side measures was correlated with the amount of improvement in hand/arm function. Normalization of MEP amplitude asymmetry in response to the 1st 2 therapy sessions predicted long-term improvement in Fugl-Meyer motor score. Within limits, TMS appears to be useful in both moderate and more impaired patients as a physiological assay of treatment-induced plasticity and behavioral gains. Methodological differences in the literature, however, currently obscure a full understanding of the potential contributions of TMS to rehabilitation research.
本研究的目的是确定皮质运动通路的经颅磁刺激（TMS）测量是否能够反映和预测偏瘫上肢康复过程中的功能改善情况。10名上肢功能障碍程度各异的患者在中风至少3个月后入组。在旨在改善功能性运动控制的每次干预前后，使用TMS获取双手肌肉的运动阈值和运动诱发电位（MEP）大小的系列测量值。在每次治疗前测量功能能力以及皮质图的面积和体积。在入组时，患侧的所有TMS测量值与健侧相比均受损，但它们并不能可靠地预测功能改善程度。运动阈值降低，而MEP波幅和图的大小随治疗增加。患侧测量值的变化量与手/臂功能的改善量相关。在前两次治疗期间MEP波幅不对称性的正常化预测了Fugl-Meyer运动评分的长期改善。在一定范围内，TMS似乎对中度和重度受损患者均有用，可作为治疗诱导可塑性和行为改善的生理检测方法。然而，目前文献中的方法学差异阻碍了对TMS对康复研究潜在贡献的全面理解。
