Hyakutake Koichi, Morishita Takashi, Saita Kazuya, Ogata Toshiyasu, Uehara Yoshinari, Shiota Etsuji, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Rehabilitation Medicine, Fukuoka University Hospital, Fukuoka, Japan.
SAGE Open Med. 2020 Jul 7;8:2050312120940546. doi: 10.1177/2050312120940546. eCollection 2020.
This pilot study aimed to investigate the safety and efficacy of transcranial direct current stimulation (tDCS) for chronic stroke in adult and pediatric patients. We also aimed to verify the efficacy of botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy involving bilateral tDCS in adult patients with chronic stroke.
We conducted a pilot study applying an unblinded, non-randomized design. Eleven patients were recruited, and classified into three groups. Group I-a involved bilateral transcranial direct current stimulation and intensive occupational therapy for chronic stroke in adult patients. Group I-b involved bilateral tDCS and intensive occupational therapy for chronic stroke in pediatric patients. Group II involved bilateral tDCS, peripheral neuromuscular electrical stimulation, and intensive occupational therapy after botulinum toxin A injection for chronic stroke in adult patients. Clinical evaluations to assess motor function and spasticity were performed at baseline as well as in 2-week and 4-month follow-up visits. The questionnaire included questions regarding the presence of tDCS side effects, such as headache, redness, pain, itching, and fever.
There were clinically meaningful changes in total Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores at the 2-week follow-up and in the Action Research Arm Test (ARAT) scores at 4-month follow-up in Group I-b. In addition, Group II showed significant improvement in total FMA-UE scores in the 2-week follow-up (p < 0.05) but not on the ARAT scores (p > 0.05). However, Group II showed improvements in total Motor Activity Log scores at both follow-up visits (p < 0.05). No serious adverse events were reported.
The results of this study indicate that tDCS therapy is a potential treatment in pediatric patients with chronic stroke. Furthermore, our data indicate that botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy may enhance the efficacy of tDCS on motor function.
本初步研究旨在调查经颅直流电刺激（tDCS）对成人和儿童慢性卒中患者的安全性和有效性。我们还旨在验证肉毒杆菌毒素A与外周神经肌肉电刺激联合双侧tDCS治疗对成人慢性卒中患者的疗效。
我们采用了一项非盲、非随机设计的初步研究。招募了11名患者，并将其分为三组。第一组-a包括对成人慢性卒中患者进行双侧经颅直流电刺激和强化职业治疗。第一组-b包括对儿童慢性卒中患者进行双侧tDCS和强化职业治疗。第二组包括对成人慢性卒中患者在注射肉毒杆菌毒素A后进行双侧tDCS、外周神经肌肉电刺激和强化职业治疗。在基线以及2周和4个月的随访中进行了评估运动功能和痉挛的临床评估。问卷包括有关tDCS副作用（如头痛、发红、疼痛、瘙痒和发烧）是否存在的问题。
在第一组-b中，2周随访时上肢Fugl-Meyer评估总分（FMA-UE）有临床意义的变化，4个月随访时行动研究臂测试（ARAT）分数有变化。此外，第二组在2周随访时FMA-UE总分有显著改善（p<0.05），但在ARAT分数上没有（p>0.05）。然而，第二组在两次随访时运动活动日志总分均有改善（p<0.05）。未报告严重不良事件。
本研究结果表明，tDCS疗法是儿童慢性卒中患者的一种潜在治疗方法。此外，我们的数据表明，肉毒杆菌毒素A与外周神经肌肉电刺激联合治疗可能会增强tDCS对运动功能的疗效。
Zotero 插件
