高频重复经颅磁刺激治疗缺血性脑卒中后运动功能障碍的功能网络研究

发布时间：2018-04-14 08:29

本文选题：缺血性脑卒中 + 重复经颅磁刺激　；参考：《川北医学院》2017年硕士论文

【摘要】：目的:采用静息态功能磁共振成像(Resting State Functional Magnetic Resonance Imaging,rs-fMRI)及临床运动功能评分量表评估重复经颅磁刺激(Repetitive Transcranial Magnetic Stimulation,rTMS)对缺血性脑卒中后运动功能障碍患者的康复疗效对运动相关功能网络的影响。方法:纳入我院神经内科大脑中动脉(Middle Cerebral Artery,MCA)区域缺血性脑卒中患者22例,随机分为两组,其中真刺激组(rTMS组)11人,伪刺激组(Sham Stimulation,Sham组)11人。rTMS组给予患侧初级运动皮层10天的高频rTMS治疗,刺激频率10Hz,刺激强度90%运动阈值;Sham组接受具有相同噪声与时间的假刺激治疗;两组患者治疗时间及其余常规治疗方法相同。治疗前、后分别对两组患者进行临床运动功能评分和rs-fMRI图像采集。采用独立成分分析(Independent Component Analysis,ICA)及延时相关方法提取脑卒中患者的运动相关静息态功能脑网络,并分析网络信息间的相关性。对比分析rTMS治疗前后及治疗后rTMS组与Sham组之间美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)、简易运动功能评分(Simple Fugel-Meyer Assessment,FMA)、日常生活能力评分(Barthel index,BI)及运动相关网络、网络间相关性的变化和差异情况。结果:(1)与治疗前相比,治疗后rTMS组与Sham组的NIHSS、FMA及BI评分较均有显著改善,且治疗后rTMS组比Sham组在FMA及BI评分上改善更明显,两者之间存在统计学差异,NIHSS两组差异不显著。(2)选取运动网络、小脑网络、执行控制网络、右侧额顶网络及突显网络5个运动相关、静息态网络进行研究。与治疗前相比,rTMS组治疗后运动网络双侧辅助运动皮层、患侧中央前回的功能连通性增加,与Sham组相比,除上述脑区外,患侧中央后回的功能连通性也增加;小脑网络的健侧小脑的功能连通性增加;右侧额顶网络在右侧顶叶的功能连通性增加。(3)治疗后运动网络与其他几个运动相关网络间相关性增加。结论:高频rTMS刺激脑卒中患者大脑患侧初级运动皮层,可以改善患者的运动功能,临床效果的改善可能与rTMS提高运动功能相关网络的联通性,促进运动相关网络间的信息整合能力有关。
[Abstract]:Objective: to evaluate the rehabilitation effect of repetitive transcranial magnetic stimulation (TMS) and repetitive Transcranial Magnetic stimulation (RTMS) in patients with motor dysfunction after ischemic stroke by using resting State Functional Magnetic Resonance imagingrs-fMRI and clinical motor function scale.The impact of the functional network.Methods: Twenty-two patients with ischemic stroke in middle Cerebral Arteryma region of neurology department in our hospital were randomly divided into two groups, including 11 patients in the true stimulation group and 11 patients in the rTMS group.The sham stimulation group (n = 11) was treated with high frequency rTMS for 10 days in the affected primary motor cortex. The stimulation frequency was 10 Hz and the stimulation intensity was 90%. The sham group received pseudostimuli with the same noise and time.The treatment time and other routine treatment methods were the same between the two groups.Before and after treatment, the clinical motor function scores and rs-fMRI images were collected.Independent component analysis (Component) and time-delay correlation were used to extract the motion-related resting functional brain network of stroke patients, and to analyze the correlation between the information of the network.The National Institutes of Health Stroke scale (NIH), simple Fugel-Meyer Assessment (rTMS), activity of Daily living (ADL) and exercise related network (NIH) were compared between rTMS group and Sham group before and after rTMS treatment.Changes and differences in the correlation between networks.Results compared with before treatment, the scores of NIHSS FMA and BI in rTMS group and Sham group were significantly improved, and the FMA and BI scores in rTMS group were significantly better than those in Sham group after treatment.There is a statistical difference between the two groups. There is no significant difference between the two groups. (2) five motion related, resting and resting networks are selected, including motor network, cerebellar network, executive control network, right frontal apex network and salient network.The functional connectivity of the precentral gyrus of the affected side increased compared with that before treatment in the rTMS group, and the functional connectivity of the postcentral gyrus of the affected side was also increased in addition to the above-mentioned areas in the Sham group.The functional connectivity of the contralateral cerebellum of the cerebellar network was increased, and the functional connectivity of the right frontal parietal network in the right parietal lobe was increased.Conclusion: high frequency rTMS stimulation of primary motor cortex in stroke patients can improve the motor function of the patients. The improvement of clinical effect may be related to the improvement of the connectivity of motor function related networks by rTMS.The ability to promote information integration among sports-related networks is relevant.
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R445.2

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