Geiger M, Roche N, Vlachos E, Cattagni T, Zory R
AP-HP, Raymond Poincaré Teaching Hospital, Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, Garches, France; CIAMS, Univ. Paris-Sud, Université Paris-Saclay, 91405 Orsay Cedex, France; CIAMS, Université d'Orléans, 45067 Orléans, France; Fondation Garches, Garches, France.
AP-HP, Raymond Poincaré Teaching Hospital, Inserm Unit 1179, Team 3: Technologies and Innovative Therapies Applied to Neuromuscular diseases, UVSQ, CIC 805, Physiology-Functional Testing Ward, Garches, France; Fondation Garches, Garches, France.
Clin Biomech (Bristol). 2019 Dec;70:1-7. doi: 10.1016/j.clinbiomech.2019.07.022. Epub 2019 Jul 24.
Muscle weakness in patients with chronic stroke is due to neuromuscular disorders such as muscle atrophy, loss of voluntary activation or weak muscle contractile properties which are majored by the imbalance of interhemispheric inhibition following stroke. In patients with chronic stroke, unilateral transcranial direct current stimulation improved the maximal isometric strength of paretic knee extensors, but bilateral transcranial direct current stimulation failed to improve concentric strength. This study aimed to assess if a bilateral current stimulation improves isometric maximal strength, voluntary activation and contractile properties of knee extensors in patients with chronic stroke.
Thirteen patients with chronic stroke and eight young healthy individuals participated in this randomized, simple-blinded, crossover study that included two experimental sessions: one with sham bilateral transcranial direct current stimulation and another with effective bilateral transcranial direct current stimulation (20 min, 2 mA). In the stroke patients, the anode was placed over the primary motor cortex of the affected hemisphere and the cathode over the contralateral primary motor cortex. In healthy participants, the brain side targeted by the anode and the cathode was randomly assigned. In each session, participants performed three assessments of strength, voluntary activation and contractile properties: before, during and after effective/sham bilateral transcranial direct current stimulation.
Bilateral transcranial direct current stimulation had no effect on any neuromuscular assessments in both groups (All P values > 0.05, partial eta-squares varied from 0.02 to 0.06).
A single session of bilateral transcranial direct current stimulation did not compensate muscular weakness of knee extensors in patients with chronic stroke.
慢性中风患者的肌肉无力是由神经肌肉疾病引起的，如肌肉萎缩、自主激活丧失或肌肉收缩特性减弱，这些主要是由中风后半球间抑制失衡所致。在慢性中风患者中，单侧经颅直流电刺激可提高患侧膝关节伸肌的最大等长肌力，但双侧经颅直流电刺激未能改善向心肌力。本研究旨在评估双侧电流刺激是否能改善慢性中风患者膝关节伸肌的等长最大肌力、自主激活和收缩特性。
13例慢性中风患者和8名年轻健康个体参与了这项随机、单盲、交叉研究，该研究包括两个实验阶段：一个阶段为双侧经颅直流电假刺激，另一个阶段为有效双侧经颅直流电刺激（20分钟，2毫安）。在中风患者中，阳极置于患侧半球的初级运动皮层上，阴极置于对侧初级运动皮层上。在健康参与者中，阳极和阴极靶向的脑侧是随机分配的。在每个阶段，参与者在有效/假双侧经颅直流电刺激之前、期间和之后进行三次力量、自主激活和收缩特性评估。
双侧经颅直流电刺激对两组的任何神经肌肉评估均无影响（所有P值>0.05，偏 eta 平方从0.02到0.06不等）。
单次双侧经颅直流电刺激不能补偿慢性中风患者膝关节伸肌的肌肉无力。
