小脑间歇性θ短阵快速脉冲刺激对脑卒中患者下肢运动功能的影响

Effects of cerebellar theta-burst stimulation on lower extremity motor function in stroke patients

目的观察小脑间歇性θ短阵快速脉冲刺激(iTBS)对脑卒中患者下肢运动功能的影响。方法2021年3月至12月,选取山东中医药大学第二附属医院康复中心脑卒中患者42例,按随机数字表法分为对照组(n=21)和观察组(n=21)。两组均进行常规药物和康复治疗,并行悬吊运动训练,包括躯干控制训练、分离运动强化训练、双下肢交替训练。观察组在悬吊运动训练前,采用小脑iTBS模式进行重复经颅磁刺激,每丛3个脉冲,丛内频率50 Hz,丛间频率5 Hz,刺激2 s,间歇8 s,共600个脉冲。分别于治疗前和治疗4周后采用Fugl-Meyer评定量表下肢部分(FMA-LE)、Berg平衡量表(BBS)和改良Barthel指数(MBI)进行评估,并比较运动诱发电位(MEP)潜伏期。结果所有患者均完成康复训练,依从性良好,无不良事件发生。治疗4周后,两组FMA-LE、BBS、MBI均较治疗前显著提高(|t|>10.053,P<0.001),观察组MEP潜伏期显著下降(t=5.326,P<0.001),且FMA-LE、BBS、MEP潜伏期均明显优于对照组(|t|>3.029,P<0.01)。结论小脑iTBS可以促进脑卒中患者下肢运动功能的恢复。

Objective To observe the effect of cerebellar intermittent theta burst stimulation(iTBS)on lower extremity motor func‐tion in stroke patients.Methods From March to December,2021,42 stroke patients in Rehabilitation Center of the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were selected and divided into control group(n=21)and observation group(n=21)according to the random number table method.Both groups received routine med‐icine and rehabilitation therapy,as well as suspension training,including trunk control training,separation exer‐cise strengthening training and alternating lower limb training.Before the suspension training,the observation group was intervened by repeated transcranial magnetic stimulation using the cerebellar iTBS mode,three pulses per plexus,the intra-cluster frequency of 50 Hz,the inter-cluster frequency of 5 Hz,and stimulated two seconds,intermited eight seconds,for 600 pulses.They were assessed with Fugl-Meyer Assessment-Lower Extremities(FMA-LE),Berg Balance Scale(BBS)and modified Barthel Index(MBI)before and four weeks after treatment,and the motor evoked potential(MEP)latencies were compared.Results All the patients completed rehabilitation training with good compliance,and no adverse events occurred.After treatment,the scores of FMA-LE,BBS and MBI increased in both groups after treatment(|t|>10.053,P<0.001),while the MEP latency decreased(t=5.326,P<0.001)in the observation group,and the scores of FMALE and BBS,and MEP latency were better in the observation group than in the control group(|t|>3.029,P<0.01).Conclusion Cerebellar iTBS can promote the recovery of lower extremity motor function in stroke patients.