Yuan Xiaoxia, Yang Yuan, Cao Na, Jiang Changhao
Beijing Key Laboratory of Physical Fitness Evaluation and Technical Analysis, Capital University of Physical Education and Sports, Beijing 100089, China.
The Center of Neuroscience and Sports, Capital University of Physical Education and Sports, Beijing 100089, China.
Brain Sci. 2020 Sep 18;10(9):648. doi: 10.3390/brainsci10090648.
Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain-stimulation technique that transiently modulates cerebral cortex excitability, achieving overall positive results in poststroke motor-function recovery. Excessive inhibition of the ipsilesional-affected hemisphere by the contralesional-unaffected hemisphere has seriously hindered poststroke motor-function recovery. Hence, intracortical disinhibition can be used as an approach to managing poststroke brain injury. This technique promotes neural plasticity for faster motor-function recovery. rTMS relieves unilateral inhibition of the brain function by regulatinga interhemispheric-imbalanced inhibition. This paper summarized 12 studies from 2016 to date, focusing on rTMS on motor function after acute and chronic stroke by regulating the interhemispheric imbalance of inhibitory inputs. Although rTMS studies have shown promising outcomes on recovery of motor functions in stroke patients, different intervention methods may lead to discrepancies in results. A uniform optimal stimulus model cannot routinely be used, mainly due to the stimulus schemes, stroke types and outcome-measuring differences among studies. Thus, the effect of rTMS on poststroke motor-function recovery should be investigated further to standardize the rTMS program for optimal poststroke motor-function recovery. More randomized, placebo-controlled clinical trials with standardized rTMS protocols are needed to ensure the effectiveness of the treatment.
重复经颅磁刺激（rTMS）是一种非侵入性脑刺激技术，可短暂调节大脑皮层兴奋性，在中风后运动功能恢复方面取得了总体积极的效果。健侧半球对患侧半球的过度抑制严重阻碍了中风后运动功能的恢复。因此，皮质内去抑制可作为一种治疗中风后脑损伤的方法。该技术可促进神经可塑性，使运动功能更快恢复。rTMS通过调节半球间不平衡抑制来减轻大脑功能的单侧抑制。本文总结了2016年至今的12项研究，重点关注通过调节抑制性输入的半球间不平衡，rTMS对急性和慢性中风后运动功能的影响。尽管rTMS研究已显示出对中风患者运动功能恢复有良好前景，但不同的干预方法可能导致结果存在差异。主要由于各研究之间的刺激方案、中风类型和结果测量存在差异，无法常规使用统一的最佳刺激模型。因此，应进一步研究rTMS对中风后运动功能恢复的影响，以规范rTMS方案，实现中风后运动功能的最佳恢复。需要更多采用标准化rTMS方案的随机、安慰剂对照临床试验来确保治疗的有效性。
