经颅高频重复磁刺激对严重偏瘫性脑卒中患者健侧运动皮质的影响：一项随机临床试验。
Effects of high-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex on motor recovery in severe hemiplegic stroke: A randomized clinical trial.
机构信息
Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Rehabilitation Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
出版信息
Brain Stimul. 2020 Jul-Aug;13(4):979-986. doi: 10.1016/j.brs.2020.03.020. Epub 2020 Apr 2.
BACKGROUND
The contralesional hemisphere compensation may play a critical role in the recovery of stroke when there is extensive damage to one hemisphere. There is little research on the treatment of hemiplegia by high-frequency repetitive transcranial magnetic stimulation (rTMS) delivered to the contralesional cortex.
OBJECTIVE
We conducted a 2-week randomized, sham-controlled, single-blind trial to determine whether high-frequency rTMS (HF-rTMS) over the contralesional motor cortex can improve motor function in severe stroke patients.
METHODS
Forty-five patients with ischemic or hemorrhagic stroke in the middle cerebral artery territory were randomly assigned to treatment with 10 Hz rTMS (HF group), 1 Hz rTMS (LF group) or sham rTMS (sham group) applied over the contralesional motor cortex (M1) before physiotherapy daily for two weeks. The primary outcome was the change in the Fugl-Meyer Motor Assessment (FMA) Scale score from baseline to 2 weeks. The secondary endpoints included root mean square of surface electromyography (RMS-SEMG), Barthel Index (BI), and contralesional hemisphere cortical excitability.
RESULTS
The HF group showed a more significant improvement in FMA score (p < 0.05), BI (p < 0.005), contralesional hemisphere cortical excitability and conductivity (p < 0.05), and RMS-SEMG of the key muscles (p < 0.05) compared with the LF group and sham group. There were no significant differences between the LF group and sham group. There was a positive correlation between cortical conductivity of the uninjured hemisphere and recovery of motor impairment (p = 0.039).
CONCLUSIONS
HF-rTMS over the contralesional cortex was superior to low-frequency rTMS and sham stimulation in promoting motor recovery in patients with severe hemiplegic stroke by acting on contralesional cortex plasticity.
TRIAL REGISTRATION
Clinical trial registered with the Chinese Clinical Trial Registry at http://www.chictr.org.cn/showproj.aspx?proj=23264 (ChiCTR-IPR-17013580).
背景
当一侧半球广泛受损时，对侧半球代偿可能在脑卒中恢复中发挥关键作用。关于高频重复经颅磁刺激（rTMS）作用于对侧皮质治疗偏瘫的研究较少。
目的
我们进行了一项为期 2 周的随机、假对照、单盲试验，以确定高频 rTMS（HF-rTMS）作用于对侧运动皮质是否能改善严重脑卒中患者的运动功能。
方法
45 例大脑中动脉区缺血性或出血性脑卒中患者被随机分为治疗组（HF 组）、低频 rTMS 组（LF 组）或假刺激组（sham 组），分别在物理治疗前每天接受 10 Hz rTMS、1 Hz rTMS 或假刺激作用于对侧运动皮质（M1），共 2 周。主要结局为从基线到 2 周时 Fugl-Meyer 运动评估量表（FMA）评分的变化。次要终点包括表面肌电图均方根值（RMS-SEMG）、Barthel 指数（BI）和对侧半球皮质兴奋性。
结果
HF 组的 FMA 评分（p < 0.05）、BI（p < 0.005）、对侧半球皮质兴奋性和传导性（p < 0.05）以及关键肌肉的 RMS-SEMG（p < 0.05）改善均明显优于 LF 组和 sham 组。LF 组和 sham 组之间无显著差异。未损伤半球皮质传导性与运动障碍恢复呈正相关（p = 0.039）。
结论
HF-rTMS 作用于对侧皮质通过作用于对侧皮质可塑性，在促进严重偏瘫脑卒中患者运动恢复方面优于低频 rTMS 和假刺激。
试验注册
中国临床试验注册中心，http://www.chictr.org.cn/showproj.aspx?proj=23264（ChiCTR-IPR-17013580）。
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