周围神经电刺激对脑卒中患者运动皮质兴奋性的影响

Effects of peripheral nerve stimulation on corticomotor excitability in patients with stroke

目的:探讨周围神经电刺激(peripheral nerve stimulation,PNS)对脑卒中患者运动皮质兴奋性的影响。方法:将31例亚急性期脑卒中患者随机分为治疗组(15例)和对照组(16例)。两组患者在接受当日常规康复治疗之外,治疗组和对照组还分别接受2h的偏瘫侧上肢尺神经和桡神经的PNS治疗和伪PNS治疗。以患手第一骨间背侧肌为靶肌肉,在治疗前和治疗后应用经颅磁刺激(transcranial magnetic stimulation,TMS)检测卒中侧大脑静息运动阈值(resting motor threshold,r MT)、运动诱发电位募集曲线(recruitment curve,RC)、运动诱发电位峰值(peak motor evoked potential,p MEP)、皮质静息期(cortical silent period,CSP)等。结果:治疗前两组患者各相关指标均无显著性差异(P>0.05)。治疗组患者接受PNS治疗后,RC斜率(P=0.01)及p MEP波幅(P=0.02)均显著增高,而r MT和CSP持续时间无显著变化(P>0.05);对照组患者接受伪PNS治疗前后,各运动皮质兴奋性指标均无显著差异(P>0.05)。重复测量方差分析显示RC斜率和p MEP波幅的时间×组别的交互效应显著(P=0.030和0.033),提示治疗前后RC斜率和p MEP波幅的变化两组之间差异具有显著性。结论:单次2h的偏瘫侧上肢周围神经电刺激可以增强亚急性期脑卒中患者患侧大脑运动皮质兴奋性。

Objective： To investigate the modulating effects of peripheral nerve stimulation （PNS） on corticomotor excitabil- ity in patients with stroke. Method： Thirty-one subacute stroke subjects were randomly assigned to 2 groups for PNS （n=15） or placebo- PNS （n=16） treatment,which was applied to the radial and ulnar nerves of the paretic arm for 2 hours. Using transcranial magnetic stimulation,the corticomotor excitability in lesioned hemisphere was measured by detecting resting motor threshold （rMT）, motor evoked potential （MEP）-recruitment curve （RC）, peak MEP and cortical si- lent period （CSP） for the contralateral first dorsal interosseous （FDI） . Result： The baseline corticomotor excitability was comparable between two groups （P〉0.05）. PNS but not place- bo-PNS resulted in significant increase in RC slope（P=0.01）and pMEP amplitude （P=0.02）. rMT and CSP du- ration showed no change after either PNS or placebo-PNS. Repeated measure ANOVA showed the interaction effect （timexgroup） was significant on RC slope （P=0.030） and pMEP amplitude （P=0.033）. Conclusion： Two-hour PNS to the paretic arm can increase the corticomotor excitability in lesioned hemisphere in people with subacute stroke.