Yozbatiran Nuray, Alonso-Alonso Miguel, See Jill, Demirtas-Tatlidede Asli, Luu Daniel, Motiwala Rehan R, Pascual-Leone Alvaro, Cramer Steven C
Stroke. 2009 Jan;40(1):309-12. doi: 10.1161/STROKEAHA.108.522144. Epub 2008 Oct 9.
Electromagnetic brain stimulation might have value to reduce motor deficits after stroke. Safety and behavioral effects of higher frequencies of repetitive transcranial magnetic stimulation (rTMS) require detailed assessment.
Using an active treatment-only, unblinded, 2-center study design, patients with chronic stroke received 20 minutes of 20 Hz rTMS to the ipsilesional primary motor cortex hand area. Patients were assessed before, during the hour after, and 1 week after rTMS.
The 12 patients were 4.7+/-4.9 years poststroke (mean+/-SD) with moderate-severe arm motor deficits. In terms of safety, rTMS was well tolerated and did not cause new symptoms; systolic blood pressure increased from pre- to immediately post-rTMS by 7 mm Hg (P=0.043); and none of the behavioral measures showed a decrement. In terms of behavioral effects, modest improvements were seen, for example, in grip strength, range of motion, and pegboard performance, up to 1 week after rTMS. The strongest predictor of these motor gains was lower patient age.
A single session of high-frequency rTMS to the motor cortex was safe. These results require verification with addition of a placebo group and thus blinded assessments across a wide spectrum of poststroke deficits and with larger doses of 20 Hz rTMS.
电磁脑刺激可能对减轻中风后的运动功能障碍有价值。高频重复经颅磁刺激（rTMS）的安全性和行为效应需要详细评估。
采用仅进行积极治疗、非盲法、2中心研究设计，慢性中风患者接受对患侧初级运动皮层手部区域进行20分钟的20赫兹rTMS治疗。在rTMS治疗前、治疗后1小时内及治疗后1周对患者进行评估。
12例患者中风后4.7±4.9年（均值±标准差），存在中度至重度上肢运动功能障碍。在安全性方面，rTMS耐受性良好，未引发新症状；收缩压从rTMS治疗前到治疗后即刻升高7毫米汞柱（P = 0.043）；且所有行为指标均未显示下降。在行为效应方面，例如握力、活动范围和插板操作等在rTMS治疗后长达1周出现适度改善。这些运动功能改善的最强预测因素是患者年龄较小。
对运动皮层进行单次高频rTMS治疗是安全的。这些结果需要通过增加安慰剂组并因此对广泛的中风后功能障碍进行盲法评估以及使用更大剂量的20赫兹rTMS来进行验证。
