Lahre Yuvraj, Bhoi Sanjeev Kumar, Jha Menka, Samal Priyanka, Naik Suprava
Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
Acta Neurol Belg. 2025 May 3. doi: 10.1007/s13760-025-02796-x.
Spasticity is a common complication of stroke limiting patient's daily activities. Transcranial magnetic stimulation is a painless and non-invasive method that can potentially reduce post-stroke spasticity (PSS). Motor evoked potentials (MEP) parameters have been shown to be related with prognosis of stroke patients. In this study we analysed the changes in MEP parameters after 3 sessions of low Hz rTMS therapy among PSS patients.
Patients with upper limb spasticity after stroke of 3 months duration were randomised into active and sham groups. In the active group three sessions of 1000 pulses, 1 Hz rTMS at an intensity of 90% of resting motor threshold were applied to the primary motor area of the contra-lesional hemisphere over three consecutive days. Sham rTMS intensity was 0% with coil placed over scalp for same duration. MEP was measured pre and post therapy in each group.
106 patients were screened of which 50 patients were selected. 25 patients were allotted to active group and 25 to sham group. Mean amplitude of MEP on stimulation of normal side was 1.98±1.70 mV before versus 1.53±1.16 mV after therapy showing significant reduction p=0.001 (95% CI-.135 - -.630). Similarly, there was significant increase in latency after therapy [22.92±2.25 ms vs 24.26±2.62 ms, p=0.001 (95% CI-2.0 - -.96)]. There was no significant change in amplitude (1.05±.69 mV vs 1.17±1.01 mV) or latency (23.66±2.45 ms vs 24.05±2.58 ms) after therapy in sham group.
MEP parameters revealed even three sessions of therapy can be helpful in supressing normal hemisphere. We found reduction in amplitude and increase in latency of MEP after low Hz rTMS therapy in contra-lesional hemisphere suggesting its suppression after therapy.
痉挛是中风的常见并发症，限制了患者的日常活动。经颅磁刺激是一种无痛且非侵入性的方法，有可能减轻中风后痉挛（PSS）。运动诱发电位（MEP）参数已被证明与中风患者的预后相关。在本研究中，我们分析了PSS患者接受3次低频重复经颅磁刺激（rTMS）治疗后MEP参数的变化。
将病程3个月的中风后上肢痉挛患者随机分为治疗组和假刺激组。治疗组连续3天对患侧半球的初级运动区施加3次，每次1000个脉冲，频率为1Hz，强度为静息运动阈值90%的rTMS。假刺激组线圈置于头皮相同位置，强度为0%，持续时间相同。每组在治疗前后测量MEP。
共筛查106例患者，入选50例。治疗组和假刺激组各25例。治疗组刺激健侧时MEP的平均波幅治疗前为1.98±1.70mV，治疗后为1.53±1.16mV，差异有统计学意义（p=0.001，95%可信区间为-0.135至-0.630）。同样，治疗后潜伏期显著延长[22.92±2.25ms对24.26±2.62ms，p=0.001，95%可信区间为-2.0至-0.96]。假刺激组治疗后波幅（1.05±0.69mV对1.17±1.01mV）和潜伏期（23.66±2.45ms对24.05±2.58ms）无显著变化。
MEP参数显示，即使3次治疗也有助于抑制健侧半球。我们发现患侧半球接受低频rTMS治疗后MEP波幅降低、潜伏期延长，提示治疗后该半球受到抑制。
