不同频率重复经颅磁刺激对脑梗死患者上肢功能的影响

Effect of repetitive transcranial magnetic stimulation with different frequencies for upper limb function in patients with cerebral infarction

目的:比较不同频率的重复经颅磁刺激(rTMS)对脑梗死患者上肢功能的影响。方法:将30例患者随机分为0.5Hz组、1Hz组和2Hz组,常规药物治疗和康复训练基础上对健侧大脑皮质M1区进行不同频率(0.5Hz、1Hz、2Hz)的rTMS治疗,持续治疗20d,于治疗前、治疗第10天及第20天时对各组患者进行疗效评定,采用上肢Fugl-Meyer评分法、上肢运动力指数(MI)、偏瘫上肢功能测试(香港版)对患者上肢功能进行评定,同时检测各组患侧脑区运动诱发电位(MEP)皮质潜伏期及中枢运动传导时间(CMCT)。结果:①上肢功能变化:治疗后3组上肢功能均明显提高,治疗10d时,0.5Hz组上肢MI评分明显高于2Hz组(P<0.05),1Hz组与其他两组组间差异无显著性意义(P>0.05);治疗20d时,0.5Hz组各项评分均优于2Hz组(P<0.05),1Hz组上肢MI评分优于2Hz组(P<0.05),0.5Hz组与1Hz组组间差异不具有显著性意义(P>0.05)。②神经电生理学变化:治疗后3组MEP皮质潜伏期及CMCT均较治疗前明显缩短,治疗10d时,0.5Hz组CMCT明显短于2Hz组(P<0.05);1Hz组与其他两组组间差异无显著性意义(P>0.05);治疗20d时,0.5Hz组MEP皮质潜伏期明显短于2Hz组(P<0.05),CMCT明显短于1Hz组和2Hz组(P<0.05);1Hz组CMCT较2Hz组缩短明显(P<0.05)。结论:0.5Hz或1Hz的重复经颅磁刺激作用于脑梗死患者健侧半球均可明显提高患侧脑区运动皮质的兴奋性,促进患侧上肢功能的恢复,且0.5Hz的刺激频率对提高患侧运动皮质的兴奋性最有效。

Objective:To compare the effect of repetitive transcranial magnetic stimulation(rTMS) with different frequencies for upper limb function in patients with cerebral infarction.Method:Thirty patients were randomly assigned to three groups receiving 0.5Hz,1Hz,and 2Hz rTMS on M 1 area of the unaffected hemisphere for 20d,respectively.In the same period,all patients were also treated with conventional medical treatment and rehabilitation training.The treatment effectiveness was assessed with upper limb function scales using Fugl Meyor assessment(FMA),motricity index(MI) and HongKong edition of functional test for the hemiplegic upper extremity(FTHUE-HK),as well as the motor evoked potential(MEP) cortical latency and central motor conduction time(CMCT) in affected brain area.The evaluation was performed before and at the 10th and 20th d over the treatment.Result:①Upper limb function improved in all 3 groups after the treatment.At the 10th day of treatment,0.5Hz group exhibited significantly higher MI score compared with 2Hz group(P>0.05).All other indices were not statistically different among the three groups(P>0.05).At the 20th d of treatment,0.5Hz group showed superior scores for all indices compared with those of 2Hz group(P>0.05).The indices of 1Hz group fell in the middle of the other two groups.No statistical significance was observed except for a higher MI score compared with 2Hz group(P>0.05).②The cortical latency of MEP and CMCT of the 3 groups reduced after treatment.At the 10th d,CMCT of 0.5Hz group was significantly shorter than that of 2Hz group(P<0.05).There was no statistical between group 1Hz and the other two groups(P>0.05).At the 20th d,CMCT in both 0.5Hz and 1Hz group were significantly shorter than that in 2Hz group(P<0.05).Cortical latency of MEP in both groups was also shorter than that in 2Hz group(P<0.05),statistical significance was observed only in 0.5Hz group(P<0.05).Conclusion:rTMS on the unaffected hemisphere of patients with cerebral infarction could improve the excitability of motor cortex of affected brain area and promote the recovery of upper limb function.Compared with 1Hz and 2Hz,0.5Hz could provide the most effective treatment.