From the Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan (Y-ZH); Institute of Cognitive Neuroscience, College of Health Sciences and Technology, National Central University, Taoyuan, Taiwan (Y-ZH); Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (L-FL, T-HL); Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan (K-HC, Y-NL); Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan (K-HC, Y-NL); and Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (C-JH).
Am J Phys Med Rehabil. 2018 May;97(5):339-345. doi: 10.1097/PHM.0000000000000850.
The potential benefits of repetitive transcranial magnetic stimulation (rTMS), applied either alone or as a combination treatment, on recovery of lower limbs after stroke have been insufficiently studied.
The aim of the study was to evaluate the effect of priming with 1-Hz repetitive transcranial magnetic stimulation over contralesional leg motor area with a double-cone coil before physical therapy on regaining ambulation.
Thirty-eight subacute stroke patients with significant leg disabilities were randomly assigned into the experimental group or control group to receive a 15-min real or sham 1-Hz repetitive transcranial magnetic stimulation, respectively, over the contralesional motor cortex representing the quadriceps muscle followed by 45-min physical therapy for 15 sessions for 3 wks. Functional measures, motor evoked potentials, and quality of life were assessed.
There was no significant difference between experimental group and control group regarding the recovery in ambulation, balance, motor functions, and activity of daily living. No significant difference was found in other functional measures and the quality of life. Only the control group displayed significantly increased cortical excitability of the contralesional hemisphere after the intervention.
The present study found that insufficient evidence that contralesional priming with 1-Hz repetitive transcranial magnetic stimulation improves ambulatory and other motor functions among patients with a severe leg dysfunction in subacute stroke.
经颅重复磁刺激（rTMS）单独应用或作为联合治疗应用于脑卒中后下肢康复的潜在益处研究不足。
本研究旨在评估双锥体线圈经颅重复磁刺激对下肢运动区的刺激对物理治疗后恢复步行能力的影响。
38 例下肢运动功能严重障碍的亚急性期脑卒中患者被随机分为实验组或对照组，分别接受 15 分钟真或假 1Hz 经颅重复磁刺激，刺激对侧代表股四头肌的运动皮质，随后进行 45 分钟物理治疗，共 15 次，持续 3 周。评估功能指标、运动诱发电位和生活质量。
实验组和对照组在步行、平衡、运动功能和日常生活活动方面的恢复情况无显著差异。其他功能指标和生活质量也无显著差异。只有对照组在干预后显示出对侧半球皮质兴奋性显著增加。
本研究发现，经颅重复磁刺激对亚急性期下肢运动功能严重障碍患者的步行和其他运动功能的改善作用证据不足。
