重复经颅磁刺激联合物理治疗对脑卒中痉挛患者皮质和脊髓兴奋性的影响。
Cortical and spinal excitability changes after repetitive transcranial magnetic stimulation combined to physiotherapy in stroke spastic patients.
机构信息
Applied Neuroscience Laboratory, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil.
Laboratory of Kinesiology and Functional Assessment, Department of Physical Therapy, Avenida Jornalista Aníbal Fernandes s/n, Universidade Federal de Pernambuco, Cidade Universitária, Recife, Pernambuco, 50740-560, Brazil.
出版信息
Neurol Sci. 2019 Jun;40(6):1199-1207. doi: 10.1007/s10072-019-03765-y. Epub 2019 Mar 9.
OBJECTIVE
Repetitive Transcranial Magnetic Stimulation (rTMS) has been used to treat post-stroke upper limb spasticity (ULS) in addition to physiotherapy (PT). To determine whether rTMS associated with PT modulates cortical and spinal cord excitability as well as decreases ULS of post-stroke patients.
METHODS
Twenty chronic patients were randomly assigned to either the intervention group-1 Hz rTMS on the unaffected hemisphere and PT, or control group-sham stimulation and PT, for ten sessions. Before and after sessions, ULS was measured using the modified Ashworth scale and cortical excitability using the output intensity of the magnetic stimulator (MSO). The spinal excitability was measured by the Hmax/Mmax ratio of the median nerve at baseline, at the end of treatment, and at the 4-week follow-up.
RESULTS
The experimental group showed at the end of treatment an enhancement of cortical excitability, i.e., lower values of MSO, compared to control group (p = 0.044) and to baseline (p = 0.028). The experimental group showed a decreased spinal cord excitability at the 4-week follow-up compared to control group (p = 0.021). ULS decreased by the sixth session in the experimental group (p < 0.05).
CONCLUSION
One-hertz rTMS associated with PT increased the unaffected hemisphere excitability, decreased spinal excitability, and reduced post-stroke ULS.
目的
除了物理疗法（PT）之外，重复经颅磁刺激（rTMS）也被用于治疗中风后上肢痉挛（ULS）。本研究旨在确定 rTMS 联合 PT 是否能调节皮质和脊髓兴奋性，降低中风患者的 ULS。
方法
20 名慢性中风患者被随机分为干预组（未受影响侧半球 1Hz rTMS 联合 PT）和对照组（假刺激联合 PT），每组各 10 次治疗。在治疗前后，采用改良 Ashworth 量表测量 ULS，使用磁刺激器输出强度（MSO）测量皮质兴奋性。在基线、治疗结束时和 4 周随访时，通过测量正中神经的 Hmax/Mmax 比值来测量脊髓兴奋性。
结果
与对照组（p=0.044）和基线时（p=0.028）相比，治疗结束时实验组的皮质兴奋性增强，即 MSO 值降低。与对照组相比，实验组在 4 周随访时脊髓兴奋性降低（p=0.021）。实验组在第六次治疗后 ULS 降低（p<0.05）。
结论
1Hz rTMS 联合 PT 可增加对侧半球兴奋性，降低脊髓兴奋性，减少中风后 ULS。
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