硬膜外植入式皮质刺激脑卒中患者提高神经网络功能

Extradural cortical stimulation for neural network recovery in stroke patients

背景:硬膜外植入式皮质刺激兼顾了经颅磁刺激、经颅直流电刺激、硬膜下皮质刺激和深部脑刺激的优点,可显著改善脑卒中后的肢体运动与语言功能。目的:综述近年来有关硬膜外植入式皮质刺激在脑卒中康复中的研究及其临床应用。方法:由第一作者应用计算机检索1995年1月至2014年4月PubMed数据库及中国期刊全文数据库文献,检索关键词为"cortical stimulation,extradural motor cortex stimulation,extradural cortical implants,extradural cortical stimulation,stroke,rehabilitation;皮质刺激,硬膜外电刺激,硬膜外皮质植入,硬膜外皮质刺激,脑卒中,康复"。纳入有关硬膜外植入式皮质刺激在脑卒中后运动与言语障碍中应用的文章。结果与结论:硬膜外皮质刺激是植入式皮质刺激,其优势是侵入性小、高度精确性和经硬膜与大脑密切接触,对缺乏有效治疗的脑卒中慢性期运动和语言障碍患者来说,这有可能是一种新的治疗方法。硬膜外皮质刺激通过促进神经可塑性、促进病灶周围结构与功能改变、提高神经网络功能、促进大脑半球间功能平衡及增加感觉输入来改善脑卒中后的肢体运动功能与语言功能。

BACKGROUND： Extradural cortical stimulation combines the advantages of repetitive transcranial magnetic stimulation, transcrenial direct current stimulation, subdural cortical stimulation and deep brain stimulation, which can significantly improve motor and language function after stroke, OBJECTIVE： To review the theoretical research and clinical application of extradural cortical stimulation for stroke recovery. METHODS： An online retrieval of PubMed database and CNKI database between January 1995 and April 2014 was performed for articles on theoretical research and clinical application of extradural cortical stimulation for stroke recovery, with the key words of ＂cortical stimulation, extradural motor cortex stimulation, extradural cortical implants, extradural cortical stimulation, stroke, rehabilitation＂ in English and Chinese, RESULTS AND CONCLUSION： Because of implantable cortical stimulation, the advantage of extradural cortical stimulation is its minimal invasiveness, high accuracy and transdural contact with the brain. For lack of effective treatment for the chronic phase of stroke patients with motor and language dysfunction, extradural cortical stimulation may be a new therapeutic method. Motor and language functional improvement must derive from reactivation of plasticity, local enhancement of perilesional areas, enhancement of network function and inter-hemispheric balance function, and amplification of sensory input.