Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
CNS Neurosci Ther. 2017 Dec;23(12):940-946. doi: 10.1111/cns.12762. Epub 2017 Oct 2.
To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on motor recovery after stroke using a prospective, double-blind, randomized, sham-controlled study.
Patients with unilateral subcortical infarction in the middle cerebral artery territory within 1 week after onset were enrolled. The patients were randomly divided into an rTMS treatment group and a sham group. We performed high-frequency rTMS or sham rTMS on the two groups. Motor functional scores were assessed pre- and post-rTMS/sham rTMS and at 1 month, 3 months, 6 months, and 1 year after stroke onset. The scores included the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Fugl-Meyer Assessment Upper Limb/Lower Limb (FMA-UL/LL), modified Rank Score (mRS), and the resting motor threshold (RMT) of the hemiplegic limb.
At baseline, no significant differences were found between the two groups for motor functional scores. On the second day after rTMS treatment, score improvements of the NIHSS, BI, FMA-UL in the real treatment group were more significant than those in the sham group. In addition, similar results were obtained at 1 month. However, at 3 months, 6 months, and 1 year after onset, no significant differences in improvement were observed between the two groups, except for the FMA-UL score improvement.
rTMS facilitates motor recovery of acute stroke patients, and the effect can last to 1 month, except the function improvement on upper extremities could last for 1 year. A single course of rTMS in the acute stage may induce the improvement of upper extremities function lasted for 1 year.
采用前瞻性、双盲、随机、假刺激对照研究，评估重复经颅磁刺激（rTMS）对卒中后运动功能恢复的疗效。
纳入发病后 1 周内单侧大脑中动脉区皮质下梗死的患者。患者随机分为 rTMS 治疗组和假刺激组。我们对两组患者分别进行高频 rTMS 或假 rTMS 治疗。在 rTMS/假 rTMS 治疗前、治疗后及卒中后 1 个月、3 个月、6 个月和 1 年分别进行运动功能评分，评分包括国立卫生研究院卒中量表（NIHSS）、巴氏指数（BI）、Fugl-Meyer 评估上肢/下肢（FMA-UL/LL）、改良 Rankin 量表（mRS）和偏瘫肢体的静息运动阈值（RMT）。
在基线时，两组的运动功能评分无显著差异。rTMS 治疗后第二天，真实治疗组 NIHSS、BI、FMA-UL 的评分改善较假刺激组更为显著。此外，在 1 个月时也得到了类似的结果。然而，在发病后 3 个月、6 个月和 1 年时，两组间的改善无显著差异，除了 FMA-UL 评分的改善。
rTMS 有助于急性卒中患者的运动功能恢复，其效果可持续 1 个月，除了上肢功能的改善可持续 1 年。急性期单次 rTMS 治疗可能会导致上肢功能的改善持续 1 年。
