持续短阵脉冲刺激对脑卒中偏瘫患者静息态脑功能连接模式的影响

Effects of single-session continuous theta burst stimulation on the connectivity pattern of poststroke pa⁃tients with hemiplegia

目的:采用功能性近红外光谱技术(functional near-infrared spectroscopy,fNIRS)和神经电生理指标观察单回合持续短阵脉冲刺激(continuous theta burst stimulation,cTBS)对脑卒中偏瘫患者静息态脑功能连接模式的影响。方法:选取脑卒中后偏瘫患者12例,采用自身交叉对照设计,在健侧M1区随机交替进行单回合c TBS经颅磁刺激干预和假刺激干预,两种干预方式间隔1周。每次干预前后采集健侧和患侧的运动诱发电位(motor evoked potential,MEP)和fNIRS静息态数据。选择双侧背外侧前额叶(dorsolateral prefrontal cortex,DLPFC)、初级运动皮质(primary motor cortex,M1)、辅助运动皮质(pre-motor and supplementary motor cortex,SMA)、初级躯体感觉皮质(primary somatosensory cortex,S1)、体感联合皮质(somatosensory association cortex,SAC)作为感兴趣区,分别做同源脑网络分析和异源脑网络分析,获得干预前后的脑功能连接图,观察运动网络功能连接模式的变化。结果:与假刺激相比,cTBS经颅磁刺激干预后,健侧第一背侧骨间肌MEP显著下降,健侧M1区的同源网络功能连接及健侧M1-患侧SMA间功能连接较干预前显著下降,差异有显著性意义(P<0.05)。结论:cTBS经颅磁刺激能够影响脑卒中偏瘫患者运动网络的静息态功能连接模式,尤以健侧M1-患侧SMA间功能连接明显,可以为神经调控治疗新策略的制定提供靶点和依据。

Objective:To observe the effect of single-session continuous theta burst stimulation(cTBS)on the connectivity pattern of poststroke patients with hemiplegia using functional near-infrared spectroscopy(fNIRS)and neurophysiological parameters.Method:For 12 patients with hemiplegia after stroke,a single session of cTBS intervention and false stimulation intervention was elicited on the healthy M1 area.The two intervention methods were a week apart.Motorevoked potential(MEP)and resting-state fNIRS data were collected on the contralesional and lesional side before and after each intervention.The bilateral dorsolateral prefrontal lobe(DLPFC),primary motor cortex(M1),pre-motor and supplementary motor cortex(SMA),primary somatosensory cortex(PSC),somatosensory association cortex(SAC),were selected as regions of interest,homologous brain network and heterologous brain network were analyzed respectively to obtain brain functional connectivity maps before and after the intervention and the changes in the functional connectivity patterns of the motor networks were observed.Result:Compared with the sham stimulation,the MEP of the first dorsal muscle in the contralesional side de creased significantly,and the functional connectivity of the homologous network in the M1 region of the contralesional side and the functional connectivity of the contralesional side M1-lesional side SMA decreased significantly with a statistically significant difference(P<0.05).Conclusion:cTBS can affect the resting-state functional connectivity pattern of motor network in stroke patients with hemiplegia,especially in the contralesional side M1-lesional side SMA,which can provide the target and basis for the development of new neuromodulatin strategies.