Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan.
Stroke. 2013 May;44(5):1375-82. doi: 10.1161/STROKEAHA.111.000522. Epub 2013 Mar 26.
Although there has been extensive research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) to improve patients' motor performance after experiencing chronic stroke, explicit findings on the coupling of different rTMS protocols are meager. We designed this sham-controlled randomized study to investigate the potential for a consecutive suppressive-facilitatory TMS protocol to improve motor outcomes after chronic stroke.
Fifty-four chronic hemiplegic stroke patients were allocated across 4 groups to undergo 20 daily sessions of (1) 1 Hz rTMS over the contralesional primary motor cortex (M1) and then intermittent theta burst stimulation over the ipsilesional M1 (group A); (2) contralesional sham stimulation and then ipsilesional real intermittent theta burst stimulation (group B); (3) contralesional real 1 Hz rTMS and then ipsilesional sham stimulation (group C); or (4) bilateral sham-control procedures (group D). We tested cortical excitability and motor activity assessments at the baseline, postpriming rTMS, and postconsequent rTMS periods.
At post, group A showed greater muscle strength, Fugl-Meyer Assessment (FMA), Wolf Motor Function test, and reaction time improvement in comparison with group B (P<0.001≈0.003) and group C (P=0.001≈0.003). Correlation analyses in group A revealed a close relation between contralesional map area decrement and Wolf Motor Function test gain (P=0.005; r=-0.75), and also revealed ipsilesional map area increment and reaction time decrement (P=0.02; r=-0.87). We detected no such relations in the other 3 groups.
Our clinical trials established an extended timeframe during which conditioning could be safely continued and produced more favorable outcomes in facilitating motor performance and ameliorating interhemispheric imbalance than those obtained from single-course rTMS modulation alone.
尽管已经有大量研究探讨了重复经颅磁刺激（rTMS）对改善慢性卒中后患者运动功能的有效性，但不同 rTMS 方案之间的关联仍缺乏明确的结论。我们设计了这项假刺激对照随机研究，旨在探讨连续抑制-易化 TMS 方案改善慢性卒中后运动功能的潜力。
将 54 例慢性偏瘫卒中患者随机分配到 4 组，分别接受 20 天的治疗：（1）对患侧初级运动皮层（M1）进行 1 Hz rTMS，然后对健侧 M1 进行间歇性经颅磁刺激（iTBS）（组 A）；（2）对患侧进行假刺激，然后对健侧进行真实 iTBS（组 B）；（3）对患侧进行真实 1 Hz rTMS，然后对健侧进行假刺激（组 C）；或（4）双侧假刺激对照（组 D）。我们在基线、rTMS 后即刻和随后 rTMS 后进行皮质兴奋性和运动活动评估。
在治疗后，与组 B（P<0.001≈0.003）和组 C（P=0.001≈0.003）相比，组 A 显示出更大的肌肉力量、Fugl-Meyer 评估（FMA）、Wolf 运动功能测试和反应时间改善。在组 A 中，相关性分析显示患侧地图面积减少与 Wolf 运动功能测试增益之间存在密切关系（P=0.005；r=-0.75），并且还显示了健侧地图面积增加和反应时间减少（P=0.02；r=-0.87）。在其他 3 组中未发现这种关系。
我们的临床试验建立了一个更长的时间框架，在此期间可以安全地继续进行条件作用，并产生比单一疗程 rTMS 调节更有利的结果，从而改善运动功能和纠正偏侧优势不平衡。
