Di Lazzaro V, Pilato F, Dileone M, Profice P, Capone F, Ranieri F, Musumeci G, Cianfoni A, Pasqualetti P, Tonali P A
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy; Fondazione Don C Gnocchi, Rome, Italy.
Institute of Neurology, Università Cattolica, largo A. Gemelli 8, 00168 Rome, Italy.
Clin Neurophysiol. 2008 Mar;119(3):715-723. doi: 10.1016/j.clinph.2007.11.049. Epub 2007 Dec 31.
Changes in cerebral cortex excitability have been demonstrated after a stroke and are considered relevant for recovery. Repetitive transcranial magnetic stimulation (rTMS) of the brain can modulate cerebral cortex excitability and, when rTMS is given as theta burst stimulation (TBS), LTP- or LTD-like changes can be induced. The aim of present study was to evaluate the effects of TBS on cortical excitability in acute stroke.
In 12 acute stroke patients, we explored the effects of facilitatory TBS of the affected hemisphere and of inhibitory TBS of the unaffected hemisphere on cortical excitability to single-pulse transcranial magnetic stimulation (TMS) on both sides. The effects produced by TBS in patients were compared with those observed in a control group of age-matched healthy individuals.
In patients, both the facilitatory TBS of the affected motor cortex and the inhibitory TBS of the unaffected motor cortex produced a significant increase of the amplitude of MEPs evoked by stimulation of the affected hemisphere. The effects observed in patients were comparable to those observed in controls.
Facilitatory TBS over the stroke hemisphere and inhibitory TBS over the intact hemisphere in acute phase enhance the excitability of the lesioned motor cortex.
TBS might be useful to promote cortical plasticity in stroke patients.
中风后大脑皮层兴奋性会发生变化,且被认为与恢复相关。对大脑进行重复经颅磁刺激(rTMS)可调节大脑皮层兴奋性,当以theta爆发式刺激(TBS)给予rTMS时,可诱导出类似长时程增强(LTP)或长时程抑制(LTD)的变化。本研究的目的是评估TBS对急性中风患者皮层兴奋性的影响。
在12例急性中风患者中,我们探究了对患侧半球进行易化性TBS以及对未患侧半球进行抑制性TBS对双侧单脉冲经颅磁刺激(TMS)皮层兴奋性的影响。将患者中TBS产生的效应与年龄匹配的健康个体对照组中观察到的效应进行比较。
在患者中,对患侧运动皮层进行易化性TBS以及对未患侧运动皮层进行抑制性TBS均使刺激患侧半球诱发的运动诱发电位(MEP)幅度显著增加。在患者中观察到的效应与在对照组中观察到的效应相当。
急性期对中风半球进行易化性TBS以及对完整半球进行抑制性TBS可增强受损运动皮层的兴奋性。
TBS可能有助于促进中风患者的皮层可塑性。