低频重复经颅磁刺激对缺血性脑卒中后痉挛性运动障碍患者的影响

Effect of Low Frequency Repetitive Transcranial Magnetic Stimulation on Patients with Spastic Dyskinesia after Ischemic Stroke

目的探讨缺血性脑卒中后痉挛性运动障碍患者低频重复经颅磁刺激的疗效及相关机制.方法选取240例缺血性脑卒中后痉挛性运动障碍患者,随机分为研究组与对照组,每组120例.对照组进行常规康复治疗,研究组在常规康复基础上加用低频重复经颅磁刺激.康复治疗前、治疗8周后使用磁刺激仪的肌电放大器记录运动诱发电位潜伏期和波幅;应用改良Ashworth量表(MAS)、Fugl-Meyer量表(FMA-UE)、改良Barthel指数评估其疗效.使用任务态fMRI检测脑激活情况,并计算初级运动区的偏侧化指数.结果治疗8周后,两组患者运动诱发电位潜伏期和波幅明显高于治疗前,MAS明显低于治疗前,其中,研究组改善效果明显优于对照组,差异具有统计学意义(P<0.05);两组患者FMA-UE评分、改良Barthel指数均明显高于治疗前,其中研究组升高幅度明显高于对照组,差异具有统计学意义(P<0.05).治疗8周后,两组患者激活脑区均由双侧激活转变为以患侧激活为主,研究组患者活动区域激活集中,但对照组患者激活区域不集中.治疗8周后,两组患者M1区偏侧化指数均明显高于治疗前,其中,研究组明显高于对照组,差异具有统计学意义(P<0.05).结论低频重复经颅磁刺激能够通过促进大脑皮层功能的重组而改善缺血性脑卒中后上肢痉挛,进而改善患者的上肢运动功能.

Objective To investigate the efficacy and mechanism of low frequency repetitive transcranial magnetic stimulation in patients with spastic dyskinesia after ischemic stroke.Method 240 patients with spastic dyskinesia after ischemic stroke were randomly divided into study group and control group,120 cases in each group.The control group received conventional rehabilitation treatment,and the study group received low frequency repetitive transcranial magnetic stimulation on the basis of conventional rehabilitation.The latency and amplitude of motor evoked potential were recorded by EMG amplifier of magnetic stimulator after 8 weeks rehabilitation.They were assessed with modified Ashworth Scale(MAS),Fugl-Meyer Scale(FMA-UE)and modified Barthel index.Brain activation was detected by task state fMRI,and lateralization index of primary motor area was calculated.Results After 8 weeks of treatment,the amplitude of motor evoked potential in the two groups was significantly higher than that before treatment,and MAS was significantly lower than that before treatment.The improvement effect of the study group was significantly better than that of the control group,and the difference was statistically significant(P<0.05);The FMA-UE score and modified Barthel index of the two groups were significantly higher than those before treatment,and the increase of the study group was significantly higher than that of the control group,the difference was statistically significant(P<0.05).After 8 weeks of trea-tment,the activated brain areas of the two groups changed from bilateral activation to ipsilateral activation,but the activated areas of the control group were not concentrated,while the activated areas of the study group were concentrated.After 8 weeks of treatment,the M1 lateralization index of the two groups were significantly higher than that before treatment,and the study group was significantly higher than the control group,the difference was statistically significant(P<0.05).Conclusion Low frequency repetitive trans-cranial magnetic stimulation can improve upper limb spasticity and motor function of patients with ischemic stroke by promoting functional reorganization of cerebral cortex.