经颅磁刺激治疗小脑性共济失调机制的研究

Transcranial Magnetic Stimulation for the Treatment of Cerebellar Ataxia

经颅磁刺激是在特定皮层内产生磁场,对皮层产生抑制或兴奋作用,从而调节相应皮层的功能。虽然临床应用广泛,但主要应用于初级运动皮层,而小脑的研究有限。小脑卒中后出现小脑齿状核-丘脑腹外侧核-皮层运动区及运动前区通路的完整性被破坏,产生共济失调等症状,对于该症状尚缺乏有效的临床康复手段,导致预后不佳,遗留严重的功能障碍,影响患者的日常生活及工作能力。现有研究发现经颅磁刺激可以调节该受损通路,改善健康受试者与小脑卒中患者的小脑功能,对小脑功能具有独特的重塑机制。该文综合分析小脑卒中的机制及经颅磁刺激作用于该通路的调节作用,探讨经颅磁刺激治疗小脑卒中的可能性,并探索更客观的评估手段及更加有效的TMS治疗模式。

Transcranial magnetic stimulation is the generation of a magnetic field in a specific cortex,which inhibits or excites the cortex and regulates the function of the corresponding cortex.Although widely used in clinical applications,it is mainly used in the primary motor cortex,while cerebellar research is limited.After the cerebellar stroke,the integrity of the cerebellar dentate nucleus-the ventrolateral nucleus of the thalamus-the cortical motor zone and the premotor zone are destroyed,resulting in ataxia and other symptoms.There is still no effective clinical rehabilitation for this symptom,resulting in poor prognosis,leaving serious dysfunction,affecting patients'daily life and work ability.Existing studies have found that transcranial magnetic stimulation can regulate this impaired pathway,improve cerebellar function in healthy subjects and cerebellar stroke patients,and have a unique remodeling mechanism for cerebellar function.This article comprehensively analyzes the mechanism of cerebellar stroke and the regulation of transcranial magnetic stimulation on this pathway,explores the possibility of transcranial magnetic stimulation in the treatment of cerebellar stroke,and explores more objective assessment methods and more effective TMS treatment mode.