Chino Toshifumi, Kinoshita Shoji, Abo Masahiro
Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Prog Rehabil Med. 2023 Mar 1;8:20230005. doi: 10.2490/prm.20230005. eCollection 2023.
Recent technological advances in non-invasive brain stimulation (NIBS) have led to the development of therapies for post-stroke upper extremity paralysis. Repetitive transcranial magnetic stimulation (rTMS), a NIBS technique, controls regional activity by non-invasively stimulating selected areas of the cerebral cortex. The therapeutic principle by which rTMS is thought to work is the correction of interhemispheric inhibition imbalances. The guidelines for rTMS for post-stroke upper limb paralysis have graded it as a highly effective treatment, and, based on functional brain imaging and neurophysiological testing, it has been shown to result in progress toward normalization. Our research group has published many reports showing improvement in upper limb function after administration of the NovEl Intervention Using Repetitive TMS and intensive one-to-one therapy (NEURO), demonstrating its safety and efficacy. Based on the findings to date, rTMS should be considered as a treatment strategy based on a functional assessment of the severity of upper extremity paralysis (Fugl-Meyer Assessment), and NEURO should be combined with pharmacotherapy, botulinum treatment, and extracorporeal shockwave therapy to maximize therapeutic effects. In the future, it will be important to establish tailormade treatments in which stimulation frequency and sites are adjusted according to the pathological conditions of interhemispheric imbalance, as revealed by functional brain imaging.
非侵入性脑刺激（NIBS）领域的最新技术进展已催生出针对中风后上肢麻痹的治疗方法。重复经颅磁刺激（rTMS）作为一种NIBS技术，通过非侵入性刺激大脑皮层的选定区域来控制局部活动。rTMS被认为起作用的治疗原理是纠正半球间抑制失衡。中风后上肢麻痹的rTMS指南将其列为一种高效治疗方法，并且基于功能性脑成像和神经生理学测试，已证明其能使病情向正常化发展。我们的研究小组发表了许多报告，表明在采用重复TMS和强化一对一治疗的新型干预方法（NEURO）后，上肢功能有所改善，证明了其安全性和有效性。基于目前的研究结果，应根据上肢麻痹严重程度的功能评估（Fugl-Meyer评估）将rTMS视为一种治疗策略，并且NEURO应与药物治疗、肉毒杆菌治疗和体外冲击波疗法相结合，以最大化治疗效果。未来，根据功能性脑成像所揭示的半球间失衡病理状况来调整刺激频率和部位，从而建立个性化治疗方法将很重要。
