低频重复经颅磁刺激对不同运动诱发电位状态的亚急性脑卒中患者运动恢复的影响：一项随机对照试验。

Effects of low frequency repetitive transcranial magnetic stimulation on motor recovery in subacute stroke patients with different motor evoked potential status: a randomized controlled trial.

作者信息

Qian Wenjun, Liao Xiaoyu, Ju Xiaowen, Gao Yaxin, Wu Miao, Xie Chen, Zhang Yaoying, Long Xianming, Qian Surong, Gong Yan

机构信息

Department of Rehabilitation Medicine, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, China.

Department of Rheumatology and Immunology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China.

出版信息

Front Neurol. 2024 Oct 17;15:1460925. doi: 10.3389/fneur.2024.1460925. eCollection 2024.

DOI:10.3389/fneur.2024.1460925

PMID:39484050

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11524934/

Abstract

OBJECTIVES

To explore the effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) on motor function and cortical excitability in stroke patients with different motor evoked potential (MEP) status.

METHODS

A total of 80 stroke patients were enrolled in this randomized controlled trial and divided into two groups according to MEP status (- or +) of lesioned hemisphere. Then, each group was randomly assigned to receive either active or sham LF-rTMS. In addition to conventional rehabilitation, all participants received 20 sessions of rTMS at 1 Hz frequency through the active or the sham coil over 4 weeks. Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Shoulder Abduction Finger Extension (SAFE) and Barthel Index (BI), bilateral resting motor threshold (rMT), amplitude of Motor evoked potential (MEP) and Central Motor Conduction Time (CMCT), and Interhemispheric asymmetry (IHA) were blindly assessed at baseline, 4 weeks and 8 weeks after treatment, respectively.

RESULTS

At 4 weeks after intervention, FMA and NIHSS changed scores in 1 Hz MEP(+) group were significantly higher than those in the other three groups ( < 0.001). After receiving 1 Hz rTMS, stroke patients with MEP(+) showed significant changes in their bilateral cortical excitability ( < 0.05). At 8 weeks after intervention, 1 Hz MEP(+) group experienced higher changes in NIHSS, FMA, SAFE, and BI scores than other groups ( < 0.001). Furthermore, 1 Hz rTMS intervention could decrease unaffected cortical excitability and enhance affected cortical excitability of stroke patients with MEP(+) ( < 0.05). The correlation analysis revealed that FMA motor change score was associated with decreased unaffected MEP amplitude ( = -0.401, = 0.010) and decreased affected rMT ( = -0.584, < 0.001) from baseline, which was only observed in the MEP(+) group.

CONCLUSION

The effects of LF-rTMS on motor recovery and cortical excitability were more effective in stroke patients with MEP than those with no MEP.

摘要

目的

探讨低频重复经颅磁刺激（LF-rTMS）对不同运动诱发电位（MEP）状态的脑卒中患者运动功能和皮质兴奋性的影响。

方法

本随机对照试验共纳入80例脑卒中患者，根据病变半球的MEP状态（-或+）分为两组。然后，每组随机分配接受主动或假LF-rTMS治疗。除常规康复治疗外，所有参与者在4周内通过主动或假线圈以1Hz频率接受20次rTMS治疗。分别在基线、治疗后4周和8周对Fugl-Meyer评估（FMA）、美国国立卫生研究院卒中量表（NIHSS）、肩外展指伸展（SAFE）和Barthel指数（BI）、双侧静息运动阈值（rMT）、运动诱发电位（MEP）幅度和中枢运动传导时间（CMCT）以及半球间不对称性（IHA）进行盲法评估。

结果

干预后4周，1Hz MEP（+）组的FMA和NIHSS变化评分显著高于其他三组（<0.001）。接受1Hz rTMS后，MEP（+）的脑卒中患者双侧皮质兴奋性有显著变化（<0.05）。干预后8周，1Hz MEP（+）组的NIHSS、FMA、SAFE和BI评分变化高于其他组（<0.001）。此外，1Hz rTMS干预可降低MEP（+）脑卒中患者未受影响侧的皮质兴奋性，并增强受影响侧的皮质兴奋性（<0.05）。相关性分析显示，FMA运动变化评分与基线时未受影响侧MEP幅度降低（=-0.401，=0.010）和受影响侧rMT降低（=-0.584，<0.001）相关，这仅在MEP（+）组中观察到。