Hummel Friedhelm C, Cohen Leonardo G
Human Cortical Physiology Section and Stroke Neurorehabilitation Clinic, National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda 20817, USA.
Lancet Neurol. 2006 Aug;5(8):708-12. doi: 10.1016/S1474-4422(06)70525-7.
Motor impairment resulting from chronic stroke can have extensive physical, psychological, financial, and social implications despite available neurorehabilitative treatments. Recent studies in animals showed that direct epidural stimulation of the primary motor cortex surrounding a small infarct in the lesioned hemisphere (M1(lesioned hemisphere)) elicits improvements in motor function.
In human beings, proof of principle studies from different laboratories showed that non-invasive transcranial magnetic stimulation and direct current stimulation that upregulate excitability within M1(lesioned hemisphere) or downregulate excitability in the intact hemisphere (M1(intact hemisphere)) results in improvement in motor function in patients with stroke. Possible mechanisms mediating these effects can include the correction of abnormally persistent interhemispheric inhibitory drive from M1(intact hemisphere) to M1(lesioned hemisphere) in the process of generation of voluntary movements by the paretic hand, a disorder correlated with the magnitude of impairment. In this paper we review these mechanistically oriented interventional approaches. WHAT NEXT?: These findings suggest that transcranial magnetic stimulation and transcranial direct current stimulation could develop into useful adjuvant strategies in neurorehabilitation but have to be further assessed in multicentre clinical trials.
尽管有可用的神经康复治疗方法，但慢性中风导致的运动功能障碍仍会产生广泛的身体、心理、经济和社会影响。最近的动物研究表明，对受损半球小梗死灶周围的初级运动皮层进行硬膜外直接刺激（M1（受损半球））可改善运动功能。
在人类中，不同实验室的原理验证研究表明，上调M1（受损半球）内兴奋性或下调完整半球（M1（完整半球））兴奋性的非侵入性经颅磁刺激和直流电刺激可改善中风患者的运动功能。介导这些效应的可能机制包括在患侧手产生自主运动过程中，纠正从M1（完整半球）到M1（受损半球）异常持续的半球间抑制驱动，这种紊乱与损伤程度相关。在本文中，我们综述了这些以机制为导向的干预方法。
下一步是什么？：这些发现表明，经颅磁刺激和经颅直流电刺激可能发展成为神经康复中有用的辅助策略，但必须在多中心临床试验中进一步评估。
