Conforto Adriana B, Santos Renata Laurenti dos, Farias Suzete Nascimento, Marie Suely Kazue Nagahashi, Mangini Nadia, Cohen Leonardo G
Neurology Department, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Clinics (Sao Paulo). 2008 Dec;63(6):735-40. doi: 10.1590/s1807-59322008000600005.
Somatosensory stimulation of the paretic upper limb enhances motor performance and excitability in the affected hemisphere, and increases activity in the unaffected hemisphere, in chronic stroke patients. We tested the hypothesis that somatosensory stimulation of the paretic hand would lead to changes in excitability of the unaffected hemisphere in these patients, and we investigated the relation between motor function of the paretic hand and excitability of the unaffected hemisphere.
Transcranial magnetic stimulation was administered to the unaffected hemisphere of nine chronic stroke patients. Patients were submitted to 2-h somatosensory stimulation in the form of median nerve stimulation and control stimulation using a cross-over design. Baseline Jebsen-Taylor test scores were evaluated. Resting motor threshold, intracortical facilitation, short-interval intracortical inhibition, and visual analog scores for attention, fatigue and drowsiness were measured across conditions.
Better pre-stimulation baseline motor function was correlated with deeper SICI in the unaffected hemisphere. We found no overt changes in any physiological marker after somatosensory stimulation. There was increased drowsiness in the control session, which may have led to changes in intracortical facilitation.
Our results do not support an overt effect of a single session of somatosensory stimulation of the paretic hand on motor cortical excitability of the unaffected hemisphere as measured by motor threshold, short-interval intracortical inhibition or intracortical facilitation. It remains to be determined if other markers of cortical excitability are modulated by somatosensory stimulation, and whether repeated sessions or lesion location may lead to different effects.
在慢性卒中患者中，对患侧上肢进行体感刺激可增强患侧半球的运动表现和兴奋性，并增加健侧半球的活动。我们检验了这样一个假设，即对患侧手进行体感刺激会导致这些患者健侧半球兴奋性发生变化，并研究了患侧手的运动功能与健侧半球兴奋性之间的关系。
对9名慢性卒中患者的健侧半球进行经颅磁刺激。采用交叉设计，让患者接受以正中神经刺激形式进行的2小时体感刺激和对照刺激。评估基线Jebsen-Taylor测试分数。在不同条件下测量静息运动阈值、皮质内易化、短间隔皮质内抑制以及注意力、疲劳和嗜睡的视觉模拟评分。
刺激前较好的基线运动功能与健侧半球较深的短间隔皮质内抑制相关。我们发现在体感刺激后任何生理指标均无明显变化。对照时段出现嗜睡增加，这可能导致了皮质内易化的改变。
我们的结果不支持单次对患侧手进行体感刺激对健侧半球运动皮质兴奋性有明显影响，这种影响通过运动阈值、短间隔皮质内抑制或皮质内易化来衡量。体感刺激是否会调节皮质兴奋性的其他指标，以及重复刺激或病变位置是否会导致不同的效果，仍有待确定。
