Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
NeuroRehabilitation. 2021;48(1):83-96. doi: 10.3233/NRE-201606.
The treatment for patients suffering from motor dysfunction following stroke using continuous repetitive transcranial magnetic stimulation (rTMS) has the potential to be beneficial for recovery. However, the impact of explicit results on the coupling of various rTMS protocols on motor treatment in patients following acute cerebral infarction remain unexplored.
The current study aims to design a sham-controlled randomized report to explore the capability of consecutive suppressive-facilitatory rTMS method to increase the motor results following acute stroke.
A hundred ischemic stroke patients suffering from motor disorder were randomly assigned to obtain 4 week sessions of (1)10 Hz over the ipsilesional primary motor cortex (M1) and next 1 Hz over the contralesional M1; (2) contralesional sham stimulation and next ipsilesional real 10 Hz; (3) contralesional real 1 Hz rTMS and next ipsilesional sham stimulation; or (4) bilateral sham-control procedures. At 24 hours before and after the intervention, we obtained cortical excitability data from study subjects. At baseline, after treatment and 3 months follow up, we additionally evaluated patients with the clinical assessments.
At post-intervention, group A showed greater motor improvements in FMA, FMA-UL, NIHSS, ADL and mRS values than group B, group C and group D, that were continued for at least 3 months after the completion of the treatment time. Specifically, it is shown in the cortical excitability study that the motor-evoked potential (MEP) amplitude and resting motor threshold (rMT) more significantly improved in group A than other groups. The improvement in motor function and change in motor cortex excitability exhibit a significant correlation in the affected hemisphere. The combined 1 Hz and 10 Hz stimulation treatment showed a synergistic effect.
Facilitatory rTMS and coupling inhibitory produced extra satisfactory results in facilitating the motor's recovery in the subacute and acute phase following stroke compared to that acquired from alone single-course modulation.
采用连续重复经颅磁刺激（rTMS）治疗脑卒中后运动功能障碍患者具有促进康复的潜力。然而，在急性脑梗死患者中，明确的结果对各种 rTMS 方案在运动治疗中的耦合影响尚未得到探索。
本研究旨在设计一项假刺激对照随机报告，以探索连续抑制-易化 rTMS 方法在增加急性脑卒中后运动结果方面的能力。
将 100 名患有运动障碍的缺血性脑卒中患者随机分为 4 周疗程，接受以下治疗：（1）同侧初级运动皮层（M1）给予 10 Hz 刺激，然后对侧 M1 给予 1 Hz 刺激；（2）对侧假刺激，然后同侧给予真实 10 Hz 刺激；（3）对侧真实 1 Hz rTMS，然后同侧给予假刺激；或（4）双侧假刺激对照程序。在干预前 24 小时和干预后，我们从研究对象中获得皮质兴奋性数据。在基线、治疗后和 3 个月随访时，我们还对患者进行了临床评估。
干预后，A 组在 FMA、FMA-UL、NIHSS、ADL 和 mRS 值方面的运动改善明显优于 B、C 和 D 组，且在治疗结束后至少 3 个月内仍持续改善。具体来说，皮质兴奋性研究表明，与其他组相比，A 组的运动诱发电位（MEP）振幅和静息运动阈值（rMT）显著改善。患侧运动功能的改善和运动皮层兴奋性的变化呈显著相关性。1 Hz 和 10 Hz 联合刺激治疗显示出协同效应。
与单一疗程调制相比，在亚急性期和急性期脑卒中后，易化 rTMS 和抑制相结合可产生更满意的效果，促进运动功能的恢复。
