Perez Carolina, Morales-Quezada Leon, Fregni Felipe
Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Boston, MA.
Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Boston, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.
Int J Neurorehabil. 2014 Nov;1(3). doi: 10.4172/2376-0281.1000123. Epub 2014 Nov 15.
Stroke is a leading cause of disability in the United States. Available treatments for stroke have only a modest effect on motor rehabilitation and about 50-60% of stroke patients remain with some degree of motor impairment after standard treatment. Non-invasive brain stimulation (NIBS) techniques have been proposed as adjuvant treatments to physical therapy for motor recovery after stroke. High frequency rTMS and anodal tDCS can be delivered over the affected motor cortex in order to increase cortical excitability and induce brain plasticity with the intention to enhance motor learning and achieve functional goals in stroke patients. Similarly, low frequency rTMS and cathodal tDCS can be delivered to the unaffected motor cortex to reduce interhemispheric inhibition and hinder maladaptive plasticity. The use of several drugs such as amphetamines, selective serotonin reuptake inhibitors (SSRIs), levodopa and cholinergic agents have been also proposed to enhance the motor function. Given that both NIBS and pharmacotherapy might provide some treatment effect independently for motor rehabilitation in stroke and with the rationale that they could work in a synergistic fashion, we believe that a combined therapy- NIBS plus pharmacotherapy- canlead to better outcomes than one or the other alone. In this paper we review the literature that support the potential use of a combined approach in stroke recovery and present the studies that have already investigated this idea.
中风是美国致残的主要原因。现有的中风治疗方法对运动康复的效果有限，约50-60%的中风患者在接受标准治疗后仍存在一定程度的运动障碍。非侵入性脑刺激（NIBS）技术已被提议作为中风后运动恢复物理治疗的辅助治疗方法。高频重复经颅磁刺激（rTMS）和阳极经颅直流电刺激（tDCS）可作用于受影响的运动皮层，以增加皮层兴奋性并诱导脑可塑性，旨在增强中风患者的运动学习并实现功能目标。同样，低频rTMS和阴极tDCS可作用于未受影响的运动皮层，以减少半球间抑制并阻碍适应性不良的可塑性。还有人提出使用几种药物，如苯丙胺、选择性5-羟色胺再摄取抑制剂（SSRI）、左旋多巴和胆碱能药物来增强运动功能。鉴于NIBS和药物治疗可能各自独立地为中风后的运动康复提供一定的治疗效果，并且基于它们可能以协同方式起作用的原理，我们认为联合治疗——NIBS加药物治疗——可能比单独使用其中一种治疗方法产生更好的效果。在本文中，我们回顾了支持联合方法在中风恢复中潜在应用的文献，并介绍了已经对这一想法进行研究的相关研究。
