理论模型及刺激靶点在重复经颅磁刺激促进中风患者上肢运动功能恢复中的研究进展

Advances of Theoretical Models and Stimulation Targets in Repetitive Transcranial Magnetic Stimulation to Promote Upper Limb Motor Function Recovery in Stroke Patients

重复经颅磁刺激已在临床中广泛用于促进中风患者上肢运动功能的恢复。当前有三种理论模型指导重复经颅磁刺激的应用:代偿模型基于脑的可塑性,半球间竞争模型强调平衡中风后两侧半球的兴奋性;在临床实践中,大部分研究主要是根据半球间竞争模型,采取低频抑制健侧半球或者是高频兴奋患侧半球的干预方法,但竞争模型可能不适用于严重脑卒中患者;在代偿模型和半球间竞争模型的基础上,提出了更完善的双相模型;双相模型引入了结构保留度的概念,并将代偿模型带入研究视野、强调健侧半球对于严重脑卒中患者的重要性,但当前并无衡量结构保留度的标准化方法,在实际应用中仍会存在问题。因此,更好的标准化方法来区分中风的严重程度,可能有益于重复经颅磁刺激更好的临床应用。大部分研究也将刺激靶点关注在初级运动皮层,但刺激初级运动皮层不总是能取得明显治疗效果。为此,有研究提出了新的靶点和多靶点刺激的方法。本文简要探讨重复经颅磁刺激的理论模型及相关刺激靶点在促进中风患者上肢运动功能恢复中的应用,以期更好的促进脑卒中后上肢运动功能恢复。

Repetitive transcranial magnetic stimulation has been extensively used in clinical practice to promote the recovery of upper limb motor function in stroke patients.There are currently three theoretical models to guide the application of repetitive transcranial magnetic stimulation:The vicariation model is based on brain plasticity.The interhemispheric competition model emphasizes the balance of excitability in the bilateral hemispheres after stroke.In clinical practice,most studies were mainly conducted according to the interhemispheric competition model and adopted the intervention method of low-frequency inhibition in the unaffected hemisphere or high-frequency excitation in the affected hemisphere,but the interhemispheric competition model may not be applicable for severe stroke patients.Based on the vicariation model and the interhemispheric competition model,a more comprehensive bimodal balance-recovery model is proposed.It introduces the concept of structural reserve and brings the vicariation model into the research perspective,emphasizing the importance of the unaffected hemisphere for severe stroke patients,but there is currently no standardized method for measuring structural reserve,which can still be problematic in practical applications.Therefore,a better standardized method of differentiating stroke severity may be beneficial for the clinical application of repetitive transcranial magnetic stimulation.Most studies also focused stimulation target on the primary motor cortex,but stimulation of the primary motor cortex did not always obtain a significant therapeutic effect.For this reason,Some studies have proposed new targets and multi-target stimulation.This paper briefly discusses the application of theoretical models and relevant stimulation targets in repetitive transcranial magnetic stimulation to promote the recovery of upper limb motor function in stroke patients,in order to better promote the recovery of upper limb motor function after stroke.