Kim Chul, Choi Hee Eun, Jung Heejin, Lee Byeong-Ju, Lee Ki Hoon, Lim Young-Joon
Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea.
Department of Rehabilitation Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
Ann Rehabil Med. 2014 Oct;38(5):585-91. doi: 10.5535/arm.2014.38.5.585. Epub 2014 Oct 30.
To compare the low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) with high frequency (20 Hz) rTMS on motor functional improvement of the affected upper extremity in subacute stroke patients.
Forty patients with subacute ischemic stroke participated in this study. The first group received 10 sessions of 20 Hz rTMS at ipsilesional M1 area and the other group received 10 sessions of 1 Hz rTMS at contralesional M1 area. Motor training of the hemiparetic hand was conducted after each rTMS train. All the patients received conventional occupational therapy immediately after each rTMS session. Manual function test (MFT), Fugl-Meyer Assessment scale (FMS), Modified Barthel Index (MBI), Brunnstrom recovery stage, and grip strength were used to assess motor function before, at the end of, and one month after the last session of rTMS.
No adverse side effects were reported during the course of the experiment using rTMS. No significant difference in motor function of the affected upper extremity was observed between the two groups before rTMS. Significant improvements in MFT, FMS, MBI, and Brunnstrom stage were observed in the both groups at the end of the last rTMS session and one month later (p<0.05). No significant difference was found between the two groups (p>0.05).
There was no significant difference in motor function of the affected upper extremity between 1 Hz and 20 Hz rTMS during the subacute period of ischemic stroke. Thus, we cannot conclude which has a greater effect.
比较低频(1赫兹)重复经颅磁刺激(rTMS)与高频(20赫兹)rTMS对亚急性卒中患者患侧上肢运动功能改善的影响。
40例亚急性缺血性卒中患者参与本研究。第一组在患侧M1区接受10次20赫兹的rTMS治疗,另一组在健侧M1区接受10次1赫兹的rTMS治疗。每次rTMS治疗后进行偏瘫手的运动训练。所有患者在每次rTMS治疗后立即接受常规职业治疗。采用手动功能测试(MFT)、Fugl-Meyer评估量表(FMS)、改良Barthel指数(MBI)、Brunnstrom恢复阶段和握力来评估rTMS最后一次治疗前、治疗结束时及治疗结束后1个月的运动功能。
在使用rTMS的实验过程中未报告不良副作用。rTMS治疗前,两组患侧上肢运动功能无显著差异。在最后一次rTMS治疗结束时及1个月后,两组的MFT、FMS、MBI和Brunnstrom阶段均有显著改善(p<0.05)。两组之间无显著差异(p>0.05)。
在缺血性卒中亚急性期,1赫兹和20赫兹rTMS对患侧上肢运动功能的影响无显著差异。因此,我们无法得出哪种方法效果更佳的结论。