低频重复经颅磁刺激联合计算机认知功能训练治疗脑卒中后记忆功能障碍的效果研究

Effects of low frequency repetitive transcranial magnetic stimulation on memory function of patients with memory dysfunction after cerebral stroke

目的观察低频重复经颅磁刺激(rTMS)对脑卒中后认知障碍患者记忆功能的影响。方法60例脑卒中后认知功能障碍患者采用电脑软件自动随机分配法分为对照组和治疗(低频rTMS)组,每组30例。2组患者均给予计算机认知功能训练,治疗组患者在此基础上辅以低频rTMS治疗。于治疗前、治疗2周、治疗4周及治疗6周时采用韦氏记忆量表(WMS)、蒙特利尔认知评估(MoCA)量表及P300对2组患者的记忆力、认知功能及电生理指标进行评定。低频rTMS采用经颅磁刺激仪及“8”字线圈,对患者健侧前额叶背外侧(dorsolateral prefrontal cortex,DLPFC)进行刺激。利用肌电图寻找可引起刺激的皮层运动区,以引起对侧手指产生50μV的动作诱发电位(MEP)。刺激频率为1 Hz,强度为80%运动阈值,每个序列20次脉冲,间隔时间3 s,52个序列,治疗时间约20 min。1次/d,每周5 d,治疗6周,共30次。结果对照组出现慢性脑积水1例,再发脑卒中1例;治疗组出现外伤后硬膜下血肿1例。共3例患者退出研究。治疗前,2组患者WMS评分、MoCA评分、ERP-P300波幅及潜伏期比较,差异均无统计学意义(P>0.05)。2组患者与治疗前相比,治疗2周及4周时,2组的WMS评分无明显上升(P<0.05);治疗6周时,2组患者WMS评分较治疗前均有不同程度上升,差异有统计学意义(P<0.05)。与对照组相比,治疗6周时,治疗组WMS评分明显上升,差异有统计学意义(P<0.05)。与治疗前相比,治疗2周时,2组MoCA评分无明显改善(P>0.05);治疗4周及6周时,2组MoCA评分均有不同程度提高,差异有统计学意义(P<0.05)。与对照组相比,治疗4周及6周时,治疗组患者MoCA评分明显改善,差异有统计学意义(P<0.05)。与治疗前相比,治疗2周时,P300潜伏期无明显缩短,波幅无明显升高(P>0.05);治疗4周及6周时,2组P300潜伏期有不同程度缩短(P<0.05),波幅有不同程度升高(P<0.05)。与对照组相比,治疗4周及6周时,rTMS组患者P300潜伏期明显缩短(P<0.05),波幅有明显升高(P<0.05)。结论低频rTMS治疗脑卒中认知功能障碍,可以提高患者的WMS评分及MOCA评分,促进记忆功能恢复;可以缩短患者的P300潜伏期及提高P300波幅;低频rTMS对脑卒中认知障碍患者记忆力的作用效果具有时间依赖性,非记忆认知成分的恢复早于记忆功能恢复。

Objective To investigate the Effects of low frequency repetitive transcranial magnetic stimulation(rTMS)on the memory function of patients with memory dysfunction after cerebral stroke.Methods Sixty patients with post-stroke cognitive dysfunction were divided into control group and low frequency rTMS treatment group,with 30 cases in each group.The patients in both groups were given computer cognitive function training,and the patients in treatment group B were supplemented with low frequency rTMS.The patient’s memory,cognitive function and electrophysiological indexes were observed and compared between the two groups before treatment,at 2w,4w,6w after treatment by means of Wechs Memory Scale(WMS),Montreal Cognitive Assessment(MoCA)scale and P300.Moreover an“8”-shaped coil of the low-frequency rTMS was used to stimulate the patient’s health side of dorsolateral prefrontal cortex(DLPFC).An electromyogram was used to find a cortical motor region that caused irritation to cause a 50μV action evoked potential(MEP)to be generated on the contralateral finger.The stimulation frequency was 1Hz,the intensity was 80%of the motion threshold,20 pulses per sequence,3 seconds interval,52 sequences,and the treatment time was about 20 minutes.The frequency of treatment was as follows:once a day,5 days a week,6-week treatment course and a total of 30 times.Results In the aspect of adverse reactions:there was 1 case of chronic hydrocephalus and 1 case of recurrent stroke in control group,and there was 1 case of subdural hematoma after trauma in group B.A total of 3 patients withdrew from the study.Before treatment,there were no significant differences in WMS scores,MoCA score,ERP-P300 amplitude and latency between the two groups(P>0.05).As compared with those before treatment,the WMS scores in both groups were not significantly increased at 2w and 4we after treatment(P>0.05),however,which at 6w after treatment,the WMS scores in both groups were significant increased(P<0.05).As compared with those in group A,the WMS scores in group B were increased significantly at 6w after treatment(P<0.05).There was no significant improvement in MoCA scores between the two groups at 2w after treatment(P>0.05).The MoCA scores at 4w and 6w after treatment in both groups were gradually increased at different degrees,and the differences were statistically significant(P<0.05).As compared with those in group A,the MoCA scores in group B were significantly improved at 4w and 6w after treatment(P<0.05).Compared with that before treatment,the incubation period of P300 was not significantly shortened,and the amplitude was not significantly increased at 2 weeks of treatment(P>0.05).After 4-week and 6-week treatment,the latency of P300 in both groups was significantly shortened(P<0.05),and the amplitude was also significantly increased(P<0.05).Compared with that in group A,the P300 latency in group B was significantly shortened after 4-wek and 6-week treatment(P<0.05),and the amplitude was also significantly increased(P<0.05).Conclusion The low-frequency rTMS treatment of stroke cognitive dysfunction can improve the WMS score and MOCA score of patients,and promote the recovery of memory function of patients,with a time-dependent effect on the memory of stroke patients with cognitive impairment,and the recovery of non-memory cognitive components is earlier than that of memory function.