高低频重复经颅磁刺激治疗卒中后上肢痉挛的对照研究

doi:10.3969/j.issn.1673-5765.2018.06.004

摘要/Abstract

摘要：

目的探讨高、低频重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）大脑初级运动皮层（M1区）治疗卒中后上肢痉挛的临床疗效及差异。

方法纳入我院神经内科和中医理疗科卒中后痉挛性偏瘫患者60例，随机分为高频rTMS组、低频rTMS组和假刺激组各20例。高频rTMS组刺激患侧M1区，刺激频率为10 Hz，刺激强度为80%运动阈值；低频rTMS组刺激健侧M1区，刺激频率为1 Hz，刺激强度为90%运动阈值；假刺激组接受相同噪声与时间的假刺激治疗。所有患者均接受常规康复治疗。各组患者分别在治疗前及治疗8周后采用改良 Ashworth痉挛评定量表（modified Ashworth scale，MAS）、Fugl-Meyer运动功能评定量表中上肢运动功能测试部分（upper extremities motor function test of Fugl-Meyer movement assessment，U-FMA）和改良Barthel指数（modified Barthel index，MBI）进行评定。以上治疗均1次/日，5次/周，连续治疗8周。

结果与治疗前相比，治疗后三组患者上肢MAS、U-FMA和MBI评分均有显著改善，差异均有统计学意义（P＜0.01）；治疗后，高频rTMS组和低频rTMS组比假刺激组的上肢MAS、U-FMA和MBI评分改善更明显，比较差异有统计学意义（P＜0.05）；但低频rTMS组和高频rTMS组上肢MAS、U-FMA和MBI评分比较，差异无统计学意义。

结论健侧低频与患侧高频rTMS刺激大脑M1区均可有效改善患者的临床症状和运动功能障碍。两种经颅磁刺激方案临床疗效相当。

文章导读： 本文通过探讨不同频率重复经颅磁刺激治疗卒中后上肢痉挛的临床疗效，结果显示高频和低频重复经颅磁刺激均可改善患者的运动功能和日常生活活动能力，两种刺激方案临床疗效相当。

关键词: 重复经颅磁刺激; 卒中; 上肢; 痉挛; 频率

Abstract:

Objective To investigate the clinical efficacy and differences of repetitive transcranial magnetic stimulation (rTMS) for high-frequency and low-frequency stimulation in the treatment of stroke upper limb spasticity. Methods A total of 60 patients from department of neurology and physiotherapy with spasticity were randomized to receive 10 Hz (n =20), 1 Hz (n =20) or sham (n =20) rTMS. The high-frequency rTMS group and the low-frequency rTMS group were given rTMS for 40 days in the ipsilesional and contralesional primary motor cortex. The stimulation frequency of the high-frequency rTMS was 10 Hz and the stimulation intensity was 80% motor threshold (MT). The stimulation frequency of the low-frequency rTMS was 1 Hz, 90% MT; the sham stimulation group received sham stimulation. All of participants received conventional rehabilitation. All the treatments were performed once a day, 5 times per week, and continued for 8 weeks. The modified Ashworth scale (MAS), upper extremities motor function test of Fugl-Meyer movement assessment (U-FMA) and modified Barthel index (MBI) were performed before and 8 weeks after treatment. Results After treatment, there was a significant improvement of MAS U-FMA and MBI scores after treatment in three groups (P <0.01). The MAS,U-FMA and MBI scores of the low-frequency group and high-frequency group were more obviously improved than that of the control group (P <0.05), but there was no significant difference between the low frequency group and the high frequency group (P >0.05). Conclusion Low-frequency stimulation of the contralesional and high-frequency stimulation of the ipsilesional M1 area can both effectively improve the clinical symptoms and motor function of the spastic patients. There was no significant difference for their clinical efficacy.

Key words: Repetitive transcranial magnetic stimulation; Stroke; Upper limb; Spasticity; Frequency

秦茵, 刘阅, 郭小平, 张长龙, 张寅鑫, 吴基伟, 胡志宏, 刘敏华, 郑颖, 刘小英. 高低频重复经颅磁刺激治疗卒中后上肢痉挛的对照研究[J]. 中国卒中杂志, 2018, 13(06): 550-555.

QIN Yin, LIU Yue, GUO Xiao-Ping, ZHANG Chang-Long, ZHANG Yin-Xin, WU Ji-Wei, HU Zhi-Hong, LIU Min-Hua, ZHENG Ying, LIU Xiao-Ying. A Comparative Study of High and Low Frequency Repetitive Transcranial Magnetic Stimulation in Treatment of Upper Limb Spasticity after Stroke[J]. Chinese Journal of Stroke, 2018, 13(06): 550-555.

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