Department of Rehabilitation Medicine, Shimizu Hospital, Tottori, Japan.
Acta Neurol Scand. 2013 Jan;127(1):26-30. doi: 10.1111/j.1600-0404.2012.01669.x. Epub 2012 Apr 12.
The purpose of this study was to test the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) over the non-lesional hemisphere on motor neuron excitability of the paretic upper limb in post-stroke patients by electrophysiological examination.
Thirteen post-stroke patients with spastic upper limb hemiparesis were studied (age, 57.5 ± 11.1 years; time after stroke, 55.2 ± 51.4 months). Low-frequency rTMS of 1 Hz was applied for 20 min to the motor cortex of the non-lesional hemisphere. The M-response amplitude and F-wave parameters were recorded in the abductor pollicis brevis muscle following stimulation of the median nerve in both the affected and unaffected upper limbs. The F-wave frequency, F-max/M ratio (ratio of maximum F-wave amplitude to M-response amplitude), and F-mean/M ratio (the ratio of mean F-wave amplitude to the M-response amplitude) were measured before and after the 20-min rTMS, analyzed for both limbs.
Application of low-frequency rTMS did not result in significant changes in the frequency of F-wave and F-max/M ratio in both upper limbs, but significantly decreased F-mean/M ratio in the affected upper limb (P < 0.005), but not in the unaffected limb.
Low-frequency rTMS applied to the non-lesional hemisphere might be potentially useful therapeutically for post-stroke patients with spastic upper limb hemiparesis.
本研究旨在通过电生理检查测试低频重复经颅磁刺激（rTMS）对病变半球对脑卒中患者患侧上肢运动神经元兴奋性的影响。
研究了 13 例伴有痉挛性上肢偏瘫的脑卒中患者（年龄 57.5±11.1 岁；脑卒中后时间 55.2±51.4 个月）。1 Hz 的低频 rTMS 应用于非病变半球的运动皮层 20 分钟。在刺激正中神经后，分别记录患侧和健侧拇短展肌的 M 反应幅度和 F 波参数。在 20 分钟 rTMS 前后分别测量双侧 F 波频率、F-max/M 比值（最大 F 波幅度与 M 反应幅度的比值）和 F-mean/M 比值（平均 F 波幅度与 M 反应幅度的比值）。
低频 rTMS 的应用并未导致双侧 F 波频率和 F-max/M 比值发生显著变化，但显著降低了患侧上肢的 F-mean/M 比值（P<0.005），而对健侧上肢无影响。
低频 rTMS 应用于非病变半球可能对脑卒中后痉挛性上肢偏瘫患者具有潜在的治疗作用。
