重复经颅磁刺激治疗对脑卒中患者运动功能及MEP的影响

发布时间：2018-08-22 11:26

【摘要】：目的：重复经颅磁刺激(repetitive transcranial magnetic stimulation rTMS)作为一种新的非侵入性脑刺激技术,现已广泛应用于卒中患者功能障碍的研究及治疗。脑卒中后两侧大脑半球间的处理过程失去调节,导致健侧大脑半球出现病理性的过度活跃、患侧大脑半球出现病理性抑制。目前关于rTMS促进脑卒中患者恢复期运动功能的恢复已经有大量研究,但研究中所采用的rTMS治疗方案仅限于患侧高频刺激治疗或者只进行健侧低频刺激的治疗,但对于双侧大脑半球同时刺激治疗的疗效目前研究不多。因此本研究的目的就是通过应用连续的抑制性—易化性rTMS治疗方案,观察该方案对脑卒中患者恢复期运动功能的恢复以及患者患侧大脑半球的运动诱发电位有无影响。方法：选择2012年10月-2014年1月间山东大学附属省立医院康复医学科住院的脑卒中恢复期患者29名,记录患者的年龄、性别、脑卒中的发病部位、种类及发病时间。将患者随机分为治疗组(15名)和对照组(14名),两组均进行相同的常规药物治疗及康复治疗(包括物理治疗、作业治疗、言语治疗、吞咽障碍的治疗、认知功能治疗、针灸、推拿等)。治疗组15名患者进行rTMS真刺激治疗,治疗方案为：先于健侧大脑皮层上肢运动代表区进行15min的1Hz低频真刺激,之后再于患侧大脑皮层上肢运动代表区进行15min的iTBS真刺激。对照组14名患者进行rTMS假刺激治疗,两侧大脑半球的刺激参数以及治疗时间相同。所有患者的评定方法均包括：患者治疗前及治疗6周后的Fugl-Meyer上肢运动功能(FMA)评分、Barthel指数(BI)评分、运动诱发电位(MEP)潜伏期、最大振幅。所有评定结果采用SPSS21进行统计学分析。结果：治疗组与对照组患者在治疗前各项功能评分无明显差异(P0.05)。治疗6周后发现,两组患者治疗后各项功能评分均较治疗前有所升高；治疗组的FMA评分、BI评分、MEP潜伏期以及MEP最大振幅均较对照组有明显改善(P0.05)。结论：连续的抑制性—易化性rTMS治疗方案包括两个治疗方案,一是对健侧大脑半球皮层运动区采用低频磁刺激,我们发现该方案能够降低健侧大脑半球皮层运动区的兴奋性,调节健侧大脑半球皮质运动区对患侧大脑半球皮质运动区的过度抑制作用,从而提高了患侧大脑半球皮质运动区的兴奋性,达到改善患侧肢体运动功能的目的；另一方案是对患侧大脑半球皮层运动区采用高频磁刺激,发现该方案能够提高患侧大脑半球皮层运动区的兴奋性,从而改善患侧肢体的运动功能。我们研究发现卒中患者在接受综合康复治疗的基础上,结合rTMS治疗,肢体功能恢复明显优于单纯康复治疗者,说明抑制性—易化性rTMS治疗方案不仅能够明显促进恢复期脑卒中患者运动功能明显恢复,而且能够调整两侧大脑半球间的整合作用,促进双侧大脑半球间的功能达到新的平衡,这为临床治疗卒中患者肢体运动功能提供了有力的理论依据与临床治疗方法。总之,rTMS是一种有效改善脑卒中恢复期患者运功功能的治疗方法,值得临床推广。
[Abstract]:Objective: repetitive transcranial magnetic stimulation (TMS), as a new non-invasive brain stimulation technique, has been widely used in the study and treatment of stroke patients with dysfunction. At present, there have been a lot of studies on the effect of rTMS on recovery of motor function in stroke patients. However, the rTMS regimen used in this study is limited to the treatment of high-frequency stimulation on the affected side or only the treatment of low-frequency stimulation on the healthy side. The purpose of this study is to investigate the effects of continuous inhibitory-facilitative rTMS on motor function recovery and motor evoked potentials in the affected hemisphere of stroke patients during convalescence.
METHODS: Twenty-nine stroke convalescent patients admitted to the Department of Rehabilitation Medicine of Shandong University Affiliated Provincial Hospital from October 2012 to January 2014 were randomly divided into treatment group (15 patients) and control group (14 patients). Treatment and rehabilitation (including physical therapy, occupational therapy, speech therapy, dysphagia treatment, cognitive function therapy, acupuncture, massage, etc.). 15 patients in the treatment group were treated with rTMS true stimulation. The treatment scheme was: 1 Hz low-frequency true stimulation was performed 15 minutes prior to the normal cerebral cortex upper limb motor area, and then on the affected cerebral cortex. All patients were assessed by Fugl-Meyer upper extremity motor function (FMA) score, Barthel index (BI) score, and exercise-induced motor function (EMF) score before and after 6 weeks of treatment. Potential (MEP) latency and maximum amplitude. All the evaluation results were analyzed by SPSS21.
Results: There was no significant difference in the functional scores between the treatment group and the control group before treatment (P 0.05). Six weeks after treatment, the functional scores of the two groups were higher than those before treatment. FMA score, BI score, MEP latency and maximum amplitude of MEP in the treatment group were significantly improved compared with the control group (P 0.05).
CONCLUSIONS: Continuous inhibitory-facilitative rTMS therapy includes two therapeutic schemes. One is low-frequency magnetic stimulation of the contralateral cerebral cortex motor area. We found that the scheme can reduce the excitability of contralateral cerebral cortex motor area and regulate contralateral cerebral cortex motor area to contralateral cerebral cortex motor area. Excessive inhibition, thus improving the excitability of the affected hemisphere cortical motor areas, to improve the motor function of the affected limbs; the other scheme is to use high-frequency magnetic stimulation of the affected hemisphere cortical motor areas, found that the program can improve the excitability of the affected hemisphere cortical motor areas, thereby improving the affected limbs. We found that on the basis of comprehensive rehabilitation treatment, combined with rTMS treatment, the recovery of limb function in stroke patients was significantly better than that in simple rehabilitation treatment, suggesting that inhibitive-facilitative rTMS treatment can not only significantly promote the recovery of motor function in convalescent stroke patients, but also can adjust both sides. The integration of cerebral hemispheres promotes a new balance between bilateral cerebral hemispheres, which provides a powerful theoretical basis and clinical treatment method for the clinical treatment of limb motor function in stroke patients.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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