Kim Jun Young, Boudier-Revéret Mathieu, Chang MinCheol
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 008253, South Korea.
Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal, Montreal, H2W 1T8, Canada.
J Integr Neurosci. 2020 Mar 30;19(1):119-123. doi: 10.31083/j.jin.2020.01.20.
The effectiveness of repetitive transcranial magnetic stimulation on the post-stroke motor recovery is not apparent. To perform an accurate evaluation, we adjusted for critical factors that determine motor outcomes, including lesion location and the state of the corticospinal tract. We only included patients with cerebral infarct in the corona radiata and with corticospinal tract interruption, apparent on diffusion tensor tractography. We retrospectively enrolled 34 patients whose diffusion tensor tractography corticospinal tract was interrupted by a cerebral infarct. The corticospinal tract state of each patient was evaluated using diffusion tensor tractography. Of the 34 patients whose corticospinal tract was interrupted on diffusion tensor tractography, 12 patients underwent repetitive transcranial magnetic stimulation treatment at the early stage after cerebral infarct (repetitive transcranial magnetic stimulation group). In comparison, 22 patients did not receive repetitive transcranial magnetic stimulation treatment (non-repetitive transcranial magnetic stimulation group). High-frequency repetitive transcranial magnetic stimulation (10 Hz) was performed on the primary motor cortex of the affected hemisphere. At the six month evaluation after the onset of the infarct, motor function was measured in each patient. In both groups, compared to their states during the initial evaluation, significant improvement was found in all measurements of motor function. However, six months after onset, no significant differences between the two groups were found in these measurement scores. When a patient's CST is interrupted, high-frequency repetitive transcranial magnetic stimulation treatment at the early stage after cerebral infarct might have no additional therapeutic effect on motor outcome. Qualified randomized controlled trials are needed to support our findings further.
重复经颅磁刺激对中风后运动恢复的有效性并不明显。为了进行准确评估，我们对决定运动结果的关键因素进行了调整，包括病变位置和皮质脊髓束的状态。我们仅纳入了放射冠区脑梗死且皮质脊髓束中断（在弥散张量纤维束成像上明显）的患者。我们回顾性纳入了34例弥散张量纤维束成像显示皮质脊髓束被脑梗死中断的患者。使用弥散张量纤维束成像评估每位患者的皮质脊髓束状态。在34例弥散张量纤维束成像显示皮质脊髓束中断的患者中，12例在脑梗死早期接受了重复经颅磁刺激治疗（重复经颅磁刺激组）。相比之下，22例患者未接受重复经颅磁刺激治疗（非重复经颅磁刺激组）。对患侧半球的初级运动皮层进行高频重复经颅磁刺激（10Hz）。在梗死发作后6个月进行评估时，测量每位患者的运动功能。在两组中，与初始评估时的状态相比，所有运动功能测量指标均有显著改善。然而，在发病6个月后，两组在这些测量分数上未发现显著差异。当患者的皮质脊髓束中断时，脑梗死早期进行高频重复经颅磁刺激治疗可能对运动结果没有额外的治疗效果。需要合格的随机对照试验来进一步支持我们的研究结果。
