高频及低频重复经颅磁刺激对急性期脑梗死患者运动功能恢复的临床研究

The clinical study of high and low-frequency repetitive transcranial magnetic stimulation on motor function recovery in patients with acute ischemic stroke

目的:观察高频(10Hz)、低频(1Hz)及高低频相结合的重复经颅磁刺激(rTMS)对急性期脑梗死患者运动功能恢复的疗效。方法:选取60例急性期脑梗死后偏瘫患者,采用单盲法完全随机设计分为4组(各15例):低频组、高频组、高低频结合组、对照组。四组均接受药物治疗及肢体康复为常规治疗。所有患者接受rTMS,治疗前和治疗后进行Fugl-Meye(rFMA)评分、美国国立卫生院神经功能缺损评分(NIHSS评分)、Barthel指数(BI)。每组各随机挑选6例患者于治疗前后进行神经电生理检查,记录运动诱发电位(MEP)潜伏期。结果:①rTMS治疗后四组FMA、NIHSS、BI均较治疗前改善(P<0.05);②rTMS治疗后高频组、低频组以及高低频结合组较对照组的FMA、BI、NIHSS评分改善(P<0.05)。且高低频结合组较高频及低频组FMA、BI评分的改善更明显(P<0.05)。③rTMS治疗后高频组和高低频结合组较本组治疗前MEP潜伏期降低(P<0.05)。且高频组较高低频结合组MEP潜伏期降低更明显(P<0.05)。结论:高频(10Hz)、低频(1Hz)、高频(10Hz)与低频(1Hz)相结合的rTMS较对照组患者运动功能的恢复更有效。其中高低频结合组的效果更为明显。另外高频(10Hz)、高频(10Hz)与低频(1Hz)相结合的rTMS能够更有效的增强患侧大脑M1区的兴奋性,促进肢体运动功能的恢复。

Objective： To observe the clinical therapeutic effects tion （rTMS） with high frequency, low frequency and covery in patients with acute ischemic stroke. of three types of repetitive transcranial magnetic stimula- combined low and high frequency on motor function re- Method： Sixty patients were randomly assigned to four groups： low frequency group, high frequency group, combined low and high frequency group and control group. All patients were also treated with conventional medical treatment and rehabilitation training. Fugl-Meyer motor assessment （FMA）, National Institutes of Health stroke scale （NIHSS） and Barthel index （BI） were evaluated at pre- and post-treatment. At pre- and post-treat- ment, 6 patients picked from each group were assessed with cortical latency of motor evoked potential （MEP） in the affected brain areas. Result： （1）Scores of FMA, NIHSS and BI improved significantly （P 〈 0.05） in all 4 groups after treatment. （2） Compared with the control group, all 3 treatment groups improved significantly in scores of FMA, BI, NIHSS （P 〈 0.05） after treatment. Combined low and high frequency group showed more improvement in FMA and BI scores than those of high frequency group and low frequency group（P〈 0.05）. （3）The cortical latency of MEP in affected brain areas reduced significantly in both high frequency group and combined low and high frequen- cy group after treatment （P 〈 0.05） and more remarkably in the high frequency group （P 〈 0.05）. Conclusion： There were significant motor function improvements in 3 treatment groups compared with the con- trol group. Additionally, combined low and high frequency group had the most significant effect. High frequen- cy group and combined low and high frequency group could improve the excitability of motor cortex of affect- ed hemisphere and promote the motor function recovery.