高频重复经颅磁刺激治疗脑卒中患者单侧空间忽略的功能磁共振研究

Effects of high frequency repetitive transcranial magnetic stimulation on stroke patients with unilateral spatial neglect:An f MRI investigation

目的:观察高频重复经颅磁刺激(r TMS)治疗脑卒中患者单侧空间忽略(USN)的临床疗效并调查r TMS疗效的神经影像学机制。方法:30例脑卒中后USN患者随机分为试验组和对照组各15例,两组患者均进行常规康复治疗;试验组给予额外的r TMS治疗,治疗强度为运动阈值的95%,频率10Hz,刺激点位于患侧右顶叶皮质区域(EEG 10-20标准的P4点),每次治疗10min,2次/d,连续治疗10天。观察治疗前及治疗10天后行为学表现和静息态f MRI改变情况。结果:和对照组相比,r TMS治疗后试验组USN症状明显改善(线段划销实验,P=0.038);图形删除测试,P=0.034;凯瑟琳-波哥量表,P<0.05);高频r TMS治疗可增强患侧脑区颞上回、额中回、顶上小叶、楔前叶及小脑前叶兴奋性,增强患侧半球的竞争抑制作用。结论:高频r TMS可明显改善脑卒中患者USN症状,并且可以使功能脑网络发生可塑性改变,平衡左右大脑半球兴奋性。

Objective： To investigate the effects of high frequency repetitive transcranial magnetic stimulation （rTMS） on stroke patients with unilateral spatial neglect （USN） and to explore the functional neuroimaging mechanisms fol- lowing rTMS intervention. Method： Thirty stroke patients with USN voluntarily participated in the present study, and they were randomly divided into the control group （CG） and experimental group （EG）. Both the CG and the EG received regular rehabilitation intervention, while the EG was treated with additional high frequency rTMS which was per- formed twice a day and I0 minutes each day for 10 days. The rTMS was conducted with 10Hz stimulation frequency and 95% intensity of the stimulation threshold.The stimulation position was located on the right pari- etal cortex （the position P4 according to the 10-20 EEG system）. All the patients received a series of neuropsy- chological tests and a resting-state fMRI scanning at baseline and 10 days after the rTMS treatment. Result： Compared to the CG, significant improvements were found in EG on tests of line cancellation （P= 0.038）, graph deletion （P=0.034） and Catherine Bergego Scale （P 〈 0.05）. Besides, the regional homogeneity （ac- tivity） of the right superior temporal gyrus, middle frontal gyrus, superior parietal lobule, precuneus and anteri- or cerebellum lobe were enhanced significantly after the rTMS intervention compared to the baseline.Conclusion： high frequency rTMS significantly improved the symptoms of USN and counterbalanced the activi- ty between the left and right hemisphere.