Turton A, Wroe S, Trepte N, Fraser C, Lemon R N
Department of Occupational Therapy, Addenbrooke's Hospital, Cambridge, UK.
Electroencephalogr Clin Neurophysiol. 1996 Aug;101(4):316-28. doi: 10.1016/0924-980x(96)95560-5.
We examined the relationship between the recovery of hand and arm function in a group of hemiplegic stroke patients and the presence of short-latency EMG responses to transcranial magnetic stimulation (TMS) in 4 different upper limb muscles (deltoid, biceps, extensor digitorum communis and the first dorsal interosseous). Twenty-one patients were examined within 5 weeks of stroke (median 2 weeks), and then at regular intervals over the next 12 months. Some patients recovered rapidly (Group A); in others, recovery was slow and incomplete (Group B). Even at the first test, Group A patients had responses to TMS in all muscles. Most Group B patients initially lacked responses in all tested upper limb muscles; in those that later were able to activate hand muscles, responses returned at or just before this stage of recovery. No such clear correlation between the presence of responses to TMS and ability to activate more proximal arm muscles was evident. Response latency was initially long and declined in a manner that was highly correlated with muscle strength and hand function test scores. Ipsilateral responses were elicited from both the affected and unaffected hemispheres. Ipsilateral responses from the latter were most common in the proximal muscles of the affected limb, and had latencies that were longer than those elicited in the contralateral (unaffected) arm. Nine cases of ipsilateral responses in hand muscles were found; such responses are not found in healthy subjects. Ipsilateral responses from the undamaged hemisphere were more prevalent in the poorly recovered patients; the underlying mechanisms may not be beneficial for recovery.
我们研究了一组偏瘫中风患者手和手臂功能的恢复情况，以及经颅磁刺激（TMS）在4块不同上肢肌肉（三角肌、肱二头肌、指总伸肌和第一骨间背侧肌）中引发的短潜伏期肌电图反应。21例患者在中风后5周内（中位时间为2周）接受检查，然后在接下来的12个月内定期接受检查。一些患者恢复迅速（A组）；另一些患者恢复缓慢且不完全（B组）。即使在首次测试时，A组患者的所有肌肉对TMS都有反应。大多数B组患者最初在所有测试的上肢肌肉中都没有反应；在那些后来能够激活手部肌肉的患者中，反应在恢复到这一阶段或在此阶段之前恢复。TMS反应的存在与激活更靠近近端的手臂肌肉的能力之间没有明显的相关性。反应潜伏期最初较长，并以与肌肉力量和手功能测试评分高度相关的方式下降。同侧反应可从患侧和未患侧半球引出。未患侧半球的同侧反应在患侧肢体的近端肌肉中最为常见，其潜伏期比在对侧（未患侧）手臂中引出的潜伏期更长。发现9例手部肌肉的同侧反应；健康受试者中未发现此类反应。未受损半球的同侧反应在恢复较差的患者中更为普遍；其潜在机制可能对恢复没有益处。
