低频重复经颅磁刺激改善脑卒中后上肢痉挛的任务态功能磁共振研究

doi:10.3969/j.issn.1006-9771.2018.07.014

《中国康复理论与实践》 ›› 2018, Vol. 24 ›› Issue (7): 828-833.doi: 10.3969/j.issn.1006-9771.2018.07.014

低频重复经颅磁刺激改善脑卒中后上肢痉挛的任务态功能磁共振研究

刘阅^1a, 王晓阳^1b, 张长龙^1a, 黄冬娥^1a, 郭小平^1a, 肖慧^1b, 吴海博^1a, 陈锦容^1a, 陈娇娇^1a, 秦茵^1a

1.中国人民解放军福州总医院,a.中医理疗科;b.医学影像科,福建福州市 350025

收稿日期:2018-05-14 修回日期:2018-06-21 出版日期:2018-07-25 发布日期:2018-08-01
通讯作者: 秦茵。E-mail: q301304@163.com
作者简介:刘阅(1993-),女,汉族,辽宁丹东市人,硕士研究生,主要研究方向：神经疾病康复。通讯作者：秦茵(1970-),女,汉族,硕士,副主任医师,硕士生导师。
基金资助:
福建省科技厅社会发展引导性(重点)项目(No. 2015Y0025)

Effects of Low-frequency Repetitive Transcranial Magnetic Stimulation on Upper Limb Spasticity after Stroke: A Task-state Functional Magnetic Resonance Study

LIU Yue^1a, WANG Xiao-yang^1b, ZHANG Chang-long^1a, HUANG Dong-e^1a, GUO Xiao-ping^1a, XIAO Hui^1b, WU Hai-bo^1a, CHEN Jin-rong^1a, CHEN Jiao-jiao^1a, QIN Yin^1a

1. a. Department of Physiotherapy; b. Department of Medical Imaging, Fuzhou General Hospital of PLA, Fuzhou, Fujian 350025, China

Received:2018-05-14 Revised:2018-06-21 Published:2018-07-25 Online:2018-08-01
Contact: QIN Yin. E-mail: q301304@163.com

摘要/Abstract

摘要： 目的探讨低频重复经颅磁刺激(rTMS)治疗脑卒中后上肢痉挛的临床疗效及其机制。方法 2015年9月至2017年12月,脑卒中后上肢痉挛患者23例随机分为对照组(n=13)和试验组(n=10)。两组均接受常规康复,试验组另加1 Hz rTMS刺激健侧初级运动区8周。治疗前后采用改良Ashworth量表(MAS)、改良Barthel指数(MBI)和Fugl-Meyer评定量表上肢部分(FMA-UE)进行评定;任务态fMRI观察大脑激活,计算偏侧化指数(LI)。结果治疗后,两组MAS、FMA-UE和MBI评分均较治疗前改善(Z>2.121, t=6.248, P<0.05),试验组高于对照组(Z>2.084, t=-2.095, P<0.05)。治疗后,患手运动时,对照组较试验组激活增强的脑区有同侧初级运动区、同侧感觉运动区及双侧辅助运动区;治疗后,两组M1区LI提高(t>2.366, P<0.05),试验组高于对照组(t=-2.430, P<0.05)。两组M1区LI变化与MAS、FMA-UE评分改善呈正相关(r>0.612, P<0.05)。结论低频rTMS可能通过促进皮层功能重组、诱导皮质功能正常化,缓解脑卒中后上肢痉挛,改善患者上肢运动功能。

关键词: 脑卒中, 痉挛, 上肢, 重复经颅磁刺激, 功能磁共振

Abstract: Objective To investigate the clinical efficacy of low-frequency transcranial magnetic stimulation (rTMS) on post-stroke upper limb spasticity and its mechanism. Methods From September, 2015 to December, 2017, 23 patients with post-stroke upper limb paralysis were randomly divided into control group (n=13) and experimental group (n=10). Both groups received routine rehabilitation, and the experimental group received 1 Hz rTMS at primary motor area (M1) for eight weeks. They were assessed with modified Ashworth Scale (MAS), modified Barthel Index (MBI) and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) before and after treatment, while the activation under fMRI in the task state was observed and the laterality index (LI) was calculated. Results The scores of MAS, FMA-UE and MBI improved after treatment in both groups (Z>2.121, t=6.248, P<0.05), and improved more in the experimental group than in the control group (Z>2.084, t=-2.095, P<0.05). The ipsilateral M1, ipsilateral sensory motor cortex and bilateral supplementary motor area were activated more in the control group than in the experimental group during the movement of affected hand. LI in the M1 increased after treatment in both groups (Z>2.366, P<0.05), and was more in the experimental group than in the control group (Z=-2.430, P<0.05). There was a positive correlation between the change of LI in the M1 and the improvement of the MAS and FMA-UE (r>0.612, P<0.05). Conclusion Low-frequency rTMS may improve the motor function and spasticity of upper limb after stroke by promoting reorganization of the cortex and inducing normalization of cortical function.

Key words: stroke, spasticity, upper limb, repetitive transcranial magnetic stimulation, functional magnetic resonance imaging

中图分类号:

R743.3

刘阅, 王晓阳, 张长龙, 黄冬娥, 郭小平, 肖慧, 吴海博, 陈锦容, 陈娇娇, 秦茵. 低频重复经颅磁刺激改善脑卒中后上肢痉挛的任务态功能磁共振研究[J]. 《中国康复理论与实践》, 2018, 24(7): 828-833.

LIU Yue, WANG Xiao-yang, ZHANG Chang-long, HUANG Dong-e, GUO Xiao-ping, XIAO Hui, WU Hai-bo, CHEN Jin-rong, CHEN Jiao-jiao, QIN Yin. Effects of Low-frequency Repetitive Transcranial Magnetic Stimulation on Upper Limb Spasticity after Stroke: A Task-state Functional Magnetic Resonance Study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2018, 24(7): 828-833.

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低频重复经颅磁刺激改善脑卒中后上肢痉挛的任务态功能磁共振研究

Effects of Low-frequency Repetitive Transcranial Magnetic Stimulation on Upper Limb Spasticity after Stroke: A Task-state Functional Magnetic Resonance Study

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