Department of Rehabilitation Medicine, Jikei University School of Medicine, Tokyo, Japan.
Acta Neurol Scand. 2013 Aug;128(2):100-6. doi: 10.1111/ane.12085. Epub 2013 Feb 7.
It is difficult to stimulate leg motor areas with magnetic current using a figure-of-eight coil due to the deep anatomical location of the areas. However, a double cone coil is useful for stimulating deep brain regions. We postulated that the use of the same coil may allow repetitive transcranial magnetic stimulation (rTMS) to modulate the neural activity of the same areas. The purpose of this study is to investigate the effect of high-frequency rTMS applied over bilateral leg motor areas with a double cone coil on walking function after stroke.
Eighteen post-stroke hemiparetic patients with gait disturbances attended two experimental sessions with more than 24 h apart, in a cross-over, double-blind paradigm. In one session, high-frequency rTMS of 10 Hz was applied over the leg motor area bilaterally in a 10-s train using a double cone coil for 20 min (total 2,000 pulses). In the other session, sham stimulation was applied for 20 min at the same site. To assess walking function, walking velocity, and Physiological Cost Index (PCI) were evaluated serially before, immediately after, and 10 and 20 min after each stimulation.
The walking velocity was significantly higher for 20 min after stimulation in the high-frequency rTMS group than the sham group. PCI was lower in the high-frequency rTMS group than the sham group, but this was significant only immediately after stimulation.
High-frequency rTMS of bilateral leg motor areas using a double cone coil can potentially improve walking function in post-stroke hemiparetic patients.
由于腿部运动区的解剖位置较深，使用八字形线圈很难用磁刺激电流对其进行刺激。然而，双锥线圈对于刺激深部脑区是有用的。我们推测，使用相同的线圈可能允许重复经颅磁刺激（rTMS）来调节相同区域的神经活动。本研究的目的是探讨使用双锥线圈对双侧腿部运动区进行高频 rTMS 刺激对脑卒中后步行功能的影响。
18 名有步态障碍的脑卒中偏瘫患者在交叉、双盲范式下，间隔超过 24 小时，参加了两个实验疗程。在一个疗程中，使用双锥线圈，以 10 Hz 的频率进行 10 s 的 10 Hz 高频 rTMS 刺激，共 2,000 个脉冲，持续 20 分钟（双侧腿部运动区）。在另一个疗程中，在同一部位进行 20 分钟的假刺激。为了评估步行功能，在每次刺激前后以及刺激后 10 和 20 分钟连续评估步行速度和生理成本指数（PCI）。
高频 rTMS 组在刺激后 20 分钟的步行速度明显高于假刺激组。高频 rTMS 组的 PCI 低于假刺激组，但仅在刺激后立即有统计学意义。
使用双锥线圈对双侧腿部运动区进行高频 rTMS 刺激可能会改善脑卒中后偏瘫患者的步行功能。
