目的:系统评价θ节律刺激(TBS)对脑卒中后患者上肢运动功能和日常生活活动能力的影响。方法:系统检索ProQuest、Scopus、PubMed、Embase、Cochrane Library、Web of Science、知网、万方、中国生物医学和维普数据库中关于TBS治疗脑卒中...目的:系统评价θ节律刺激(TBS)对脑卒中后患者上肢运动功能和日常生活活动能力的影响。方法:系统检索ProQuest、Scopus、PubMed、Embase、Cochrane Library、Web of Science、知网、万方、中国生物医学和维普数据库中关于TBS治疗脑卒中患者的随机对照试验,检索时间为建库至2021年4月。由两位评审员运用Cochrane手册对纳入文献进行风险质量评估,并在数据提取后运用RevMan5.3进行统计学分析。结果:最终获得14项研究,共329例受试者。Meta分析结果显示,与常规康复组相比,TBS组在降低美国国立卫生研究院卒中量表(NIHSS)评分[WMD=-4.11,95%CI:-6.99~-1.23,P=0.005],提高改良Barthel指数评分(MBI)[WMD=9.54,95%CI:3.81~15.27,P=0.001]和改善手臂动作调查测试表评分(ARAT)[WMD=8.83,95%CI:3.26~14.40,P=0.002]方面更优,差异有统计学意义(P<0.05)。另外,TBS组在提高上肢Fugl-Meyer量表(UE-FMA)评分[WMD=7.24,95%CI:2.18~12.31,P=0.005]方面优于常规康复组;且亚组结果显示间歇性TBS(ITBS)在提高UE-FMA评分上可能比连续性TBS(CTBS)效果更优(P=0.04)。结论:基于当前证据,TBS可有效改善脑卒中患者上肢运动功能和日常生活活动能力,上述结论仍需更多高质量研究进一步证实。展开更多
脑卒中已经成为中国主要的死亡和残疾原因,卒中后早期康复被广泛认为是促进卒中后患者功能恢复的有效手段。重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)作为一种非药物治疗脑卒中后功能障碍的方法,目前已广泛...脑卒中已经成为中国主要的死亡和残疾原因,卒中后早期康复被广泛认为是促进卒中后患者功能恢复的有效手段。重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)作为一种非药物治疗脑卒中后功能障碍的方法,目前已广泛应用于临床治疗。间歇性θ节律刺激(intermittent theta burst stimulation,iTBS)作为rTMS的一种新型治疗策略,其疗程更短,刺激强度更低,相对安全且高效。本文对iTBS在脑卒中后康复治疗中的应用做出了总结,重点关注了其在卒中后肢体功能障碍、认知障碍、失语和吞咽障碍等方面的效果。尽管其在康复中的效果已被证实,但关于iTBS的作用机制仍需进一步研究,其刺激参数、治疗频率及靶点选择也仍待进一步优化。综合而言,iTBS作为一种康复治疗方法,展现了其广泛的应用前景,但仍需深入研究以揭示其作用机制、优化治疗方案,以更好地满足卒中后患者的个体化康复需求。展开更多
Objective There is substantial evidence supporting the notion that the anterior cingulate cortex （ACC） is an important limbic structure involved in multiple brain functions such as sensory perception, motor conflict...Objective There is substantial evidence supporting the notion that the anterior cingulate cortex （ACC） is an important limbic structure involved in multiple brain functions such as sensory perception, motor conflict monitoring, memory, emotion and cognition. It has been shown that long term potentiation （LTP） is an important synaptic model of neural plasticity in the ACC, however, little is known about the spatiotemporal properties of ACC at network level. The present study was designed to see the LTP induction effects across different layers of the ACC by using different conditioning stimuli （CS） protocols. Methods A unique multi-electrode array recording technique was used in the acutely-dissociated ACC slices of rats. Long and short train theta burst stimulation （TBS） paradigms were applied in layer V-VI as the CS and the LTP induction effects were compared across different layers of the ACC. Briefly, both long and short train TBS are composed of bursts （4 pulses at 100 Hz） with a 200 ms interval, however, the former （TBS1） was with 10 trains and the latter （TBS2） was with 5 trains. After test stimulation at layer V-VI in the ACC, network field potentials （FPs） could be simultaneously recorded across all layers of the ACC. Results The waveforms of FPs were different across different layers. Namely, positive-going waveforms were recorded in layer I and negative-going waveforms were recorded in layers V-VI, in contrast, complex waveforms were localized mainly in layers II-III. Following application of two CS protocols, the induction rate of LTP was significantly different between TBS 1 and TBS2 regardless of the spatial properties. TBS1 had more than 60% success, while TBS2 was less than 25% in induction of LTP. Moreover, both the 2 CS protocols could induce LTP in layers II-III and layers V-VI without layer-related difference. However, no LTP was inducible in layer I. Conclusion The present findings indicate that stimulation protocols may, at least in part, account for a large portion of variations among previous LTP studies, and hence highlight the importance of selecting the best LTP induction protocol when designing such experiments. Moreover, the present results demonstrate the prominent superiority of multi-electrode array recording in revealing the network properties of synaptic activities in the ACC, especially in comparing the spatiotemporal characteristics between different layers of this structure.展开更多
文摘目的:系统评价θ节律刺激(TBS)对脑卒中后患者上肢运动功能和日常生活活动能力的影响。方法:系统检索ProQuest、Scopus、PubMed、Embase、Cochrane Library、Web of Science、知网、万方、中国生物医学和维普数据库中关于TBS治疗脑卒中患者的随机对照试验,检索时间为建库至2021年4月。由两位评审员运用Cochrane手册对纳入文献进行风险质量评估,并在数据提取后运用RevMan5.3进行统计学分析。结果:最终获得14项研究,共329例受试者。Meta分析结果显示,与常规康复组相比,TBS组在降低美国国立卫生研究院卒中量表(NIHSS)评分[WMD=-4.11,95%CI:-6.99~-1.23,P=0.005],提高改良Barthel指数评分(MBI)[WMD=9.54,95%CI:3.81~15.27,P=0.001]和改善手臂动作调查测试表评分(ARAT)[WMD=8.83,95%CI:3.26~14.40,P=0.002]方面更优,差异有统计学意义(P<0.05)。另外,TBS组在提高上肢Fugl-Meyer量表(UE-FMA)评分[WMD=7.24,95%CI:2.18~12.31,P=0.005]方面优于常规康复组;且亚组结果显示间歇性TBS(ITBS)在提高UE-FMA评分上可能比连续性TBS(CTBS)效果更优(P=0.04)。结论:基于当前证据,TBS可有效改善脑卒中患者上肢运动功能和日常生活活动能力,上述结论仍需更多高质量研究进一步证实。
基金supported by the National Basic Research (973) Program of China (No.2006CB500800)the National Natural Science Foundation of China (No. 30670692 and 30770668)
文摘Objective There is substantial evidence supporting the notion that the anterior cingulate cortex （ACC） is an important limbic structure involved in multiple brain functions such as sensory perception, motor conflict monitoring, memory, emotion and cognition. It has been shown that long term potentiation （LTP） is an important synaptic model of neural plasticity in the ACC, however, little is known about the spatiotemporal properties of ACC at network level. The present study was designed to see the LTP induction effects across different layers of the ACC by using different conditioning stimuli （CS） protocols. Methods A unique multi-electrode array recording technique was used in the acutely-dissociated ACC slices of rats. Long and short train theta burst stimulation （TBS） paradigms were applied in layer V-VI as the CS and the LTP induction effects were compared across different layers of the ACC. Briefly, both long and short train TBS are composed of bursts （4 pulses at 100 Hz） with a 200 ms interval, however, the former （TBS1） was with 10 trains and the latter （TBS2） was with 5 trains. After test stimulation at layer V-VI in the ACC, network field potentials （FPs） could be simultaneously recorded across all layers of the ACC. Results The waveforms of FPs were different across different layers. Namely, positive-going waveforms were recorded in layer I and negative-going waveforms were recorded in layers V-VI, in contrast, complex waveforms were localized mainly in layers II-III. Following application of two CS protocols, the induction rate of LTP was significantly different between TBS 1 and TBS2 regardless of the spatial properties. TBS1 had more than 60% success, while TBS2 was less than 25% in induction of LTP. Moreover, both the 2 CS protocols could induce LTP in layers II-III and layers V-VI without layer-related difference. However, no LTP was inducible in layer I. Conclusion The present findings indicate that stimulation protocols may, at least in part, account for a large portion of variations among previous LTP studies, and hence highlight the importance of selecting the best LTP induction protocol when designing such experiments. Moreover, the present results demonstrate the prominent superiority of multi-electrode array recording in revealing the network properties of synaptic activities in the ACC, especially in comparing the spatiotemporal characteristics between different layers of this structure.
