Liepert Joachim, Zittel Simone, Weiller Cornelius
Department of Neurology, University Hospital, Freiburg, Germany.
Restor Neurol Neurosci. 2007;25(5-6):461-5.
Increasing evidence suggests that the contralesional motor cortex (M1) inhibits the ipsilesional M1 in stroke patients. This inhibition could impair motor function of the affected hand. We investigated if inhibitory 1~Hz repetitive transcranial magnetic stimulation (rTMS) over the contralesional M1 improved motor performance of the affected hand in acute stroke.
A double-blind study of real versus placebo rTMS was conducted. Twelve patients early after subcortical stroke (mean: 7 days) received 1200 stimuli of real and placebo rTMS in a crossover design. The sequence of stimulations was counterbalanced across subjects. Stimulus intensity was subthreshold (90% of motor threshold at rest). Motor function was tested by grip strength recordings and Nine Hole Peg Test (NHPT) executions before and after each rTMS session.
Compared to sham stimulation, real rTMS improved NHPT results but not grip strength in the affected hand. No change of performance was observed for the unaffected hand. NHPT baseline repetitions in a subgroup of patients indicated stable motor performance prior to the rTMS sessions.
The study suggests that therapeutic rTMS applications over the contralesional hemisphere are feasible in acute stroke patients and can transiently improve dexterity of the affected hand. RTMS may become an additional tool for early neurorehabilitation.
越来越多的证据表明，中风患者的对侧运动皮层（M1）会抑制同侧M1。这种抑制可能会损害患侧手的运动功能。我们研究了对侧M1上的1赫兹抑制性重复经颅磁刺激（rTMS）是否能改善急性中风患者患侧手的运动表现。
进行了一项关于真实rTMS与安慰剂rTMS的双盲研究。12名皮质下中风早期（平均7天）的患者采用交叉设计接受了1200次真实和安慰剂rTMS刺激。刺激顺序在受试者之间进行了平衡。刺激强度为阈下（静息时运动阈值的90%）。在每次rTMS治疗前后，通过握力记录和九孔插钉试验（NHPT）执行情况来测试运动功能。
与假刺激相比，真实rTMS改善了患侧手的NHPT结果，但未改善握力。未受影响的手的表现未观察到变化。一组患者的NHPT基线重复次数表明在rTMS治疗前运动表现稳定。
该研究表明，在对侧半球进行治疗性rTMS应用对急性中风患者是可行的，并且可以暂时改善患侧手的灵活性。rTMS可能成为早期神经康复的一种额外工具。
