重复经颅磁刺激治疗脑卒中后下肢运动功能障碍的Scoping综述

doi:10.3969/j.issn.1006-9771.2023.03.007

Abstract

Abstract:

Objective To summarize and analyze the protocols of repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke lower limb dysfunction.

Methods Literature about rTMS for lower limb dysfunction of patients post stroke were retrieved from Web of Science, PubMed, CNKI, and Wanfang Data from inception to August 17, 2022. The quality of the literature was evaluated with Physiotherapy Evidence Database (PEDro) scale. Literature quality, data extraction and scoping review were performed by two researchers.

Results A total of 21 studies were included, in which 20 studies suggested that rTMS treatment could promote the recovery of lower limb motor function after stroke. One study showed negative result. rTMS interventions were reported safe, with no serious adverse reactions. There were great heterogeneity in the demographic and clinical information, study protocols, stimulation parameters, coil types, targets of stimulation, and motor-evoked potential measurement in the included studies.

Conclusion The future protocols of rTMS need to be combined with stroke stage and severity of injury. There is a demand for more real vs. sham rTMS studies, reporting similar designs with sufficient information, to achieve a significant level of evidence regarding the use of rTMS in post-stroke patients.

Key words: stroke, repetitive transcranial magnetic stimulation, lower limb, motor function, scoping review

CLC Number:

R743.3

HUANG Kaiqi, XIN Rong, LING Gengqiang, WANG Pu. Repetitive transcranial magnetic stimulation for lower limb dysfunction post stroke: a scoping review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 286-293.

Figures/Tables 4

纳入研究	性质(梗死/出血)/n	年龄/岁	病程	研究设计	部位	方案	频率/Hz	线圈	强度 /RMT	观察指标	主要结果
Kakuda等^[16](2013)	6/12	30~70	> 12个月	单组试验	双侧下肢皮质运动区	每次20 min，每天2次，共13 d	10	双锥形	90%	10MWT，PCI	改善下肢步行功能
杨露等^[17](2016)	17/11	56.4±7.8	> 6个月	RCT	M1区	每次20 min，每天1次，每周6 d，共4周	10	“8”字形	90%	FMA-LE，步态分析系统测试	改善下肢运动功能
Cha等^[18](2017)	19/11	40~60	< 6 个月	RCT	M1区	每次10 min，每天1次，每周5 d，共8周	10	“8”字形	90%	MEP，等速测力仪测量踝关节肌肉力量，10MWT	肌力改善、步行速度提高
Chieffo等^[19](2021)	7/5	25~80	≥ 6个月	交叉实验	双侧下肢皮质运动区	每次15 min，共3周，第1周5次，第2周3次，第3周3次	20	H形	90%	FMA-LE，MAS，10MWT，6MWT	改善运动功能和痉挛
Ji等^[20](2016)	21/9	40~60	< 3个月	RCT	M1区	每次15 min，每天1次，每周5 d，共4周	10	“8”字形	80%	动态平衡仪，静态平衡仪	改善静态平衡和动态平衡功能
Chieffo等^[21](2014)	5/5	49~74	> 6个月	交叉研究	双侧下肢皮质运动区	每次30 min，第1周5次，第2周3次，第3周3次，共3周	20	H形	90%	FMA-LE，10MWT，6MWT	FMA-LE评分改善，步行速度无明显改变
杨阳等^[22](2015)	73/47	58.7±3.5	(4.6±1.2) d	RCT	M1区	每次15 min，每天1次，每周5 d，共8周	2	“8”字形	90%	FMA-LE，10MWT，CSI，FAC	改善肢体运动功能
Sasaki等^[23](2017)	11/10	61.4±13.7	(10.9±6.6) d	RCT	双侧下肢皮质运动区	每次10 min，每天2次，共5 d	10	双锥形	90%	Brunnstrom分期，ABMSII	改善下肢运动功能
Choi等^[24](2016)	20/10	60~85	6~10个月	交叉研究	患侧躯干运动皮质区	每次10 min，每天1次，每周5 d，共2周	10	“8”字形	90%	BBS，动态平衡评估	改善平衡功能
Wang等^[25](2019)	6/8	53.5 ± 13.7	> 6个月	RCT	患侧下肢皮质运动区	每次15 min，每天1次，每周3 d，共3周	5	“8”字形	90%	步态分析，MEP，肌电图，FMA-LE	改善下肢运动功能、下肢肌肉激活程度
Kakuda等^[26](2013)	5/13	30~70	> 12个月	交叉研究	双侧下肢皮质运动区	每次20 min，共1次	10	双锥形	90%	10MWT，PCI	改善下肢步行功能
Goh等^[27](2020)	14/1	43~76	(22.8±16.7)个月	重复测量	患侧DLPFC	每次5 min，共1次	5	“8”字形	90%	测量单任务和双任务步行速度	双任务步行速度改善

纳入研究		年龄/岁	病程	研究设计	部位	方案	频率/Hz	线圈	强度 /RMT	观察指标	主要结果
Rastgoo等^[28](2016)	15/5	> 18	(30.2±18.3)个月	交叉试验	健侧下肢皮质运动区	每次20 min, 每天1次，每周5 d，共4周	1	“8”字形	90%	MAS，FMA-LE，H反射，TUGT	下肢痉挛改善，运动功能改善
李亚梅等^[29](2016)	60/0	18~75	> 3个月	RCT	健侧M1区	每次20 min, 每天1次，每周5 d，共4周	1	“8”字形	90%	FMA-LE，10MWS	偏瘫下肢运动功能改善
Huang等^[30](2018)	25/13	61.2±9.4	(25.9±18.1) d	RCT	健侧下肢皮质运动区	每次15 min, 每天1次，共15 d	1	双锥形	120%AMT	TUGT，PASS， FMA-LE，BI， SS-QOL，MEP	下肢平衡、运动无明显改善；假刺激组健侧半球皮质兴奋性增加
Lin等^[31](2015)	22/10	18~80	10~90 d	RCT	健侧M1区	每次15 min, 每天1次，共15 d	1	“8”字形	80%	PASS，POMA-b，FMA-LE，BI，TUGT	亚急性期脑卒中患者的平衡、日常生活活动及步行功能改善
黄长耀等^[32](2018)	19/11	60.67±10.95	< 1个月	RCT	健侧M1区	每次20 min, 每天1次，共10 d	1	“8”字形	80%	日本东京大学平衡量表，Tetrax平衡测试，MEP	站立平衡功能改善
Forogh等^[33](2017)	26/0	53~79	> 1个月	RCT	健侧M1区	每次20 min，每天1次，共5 d	1	“8”字形	90%	FMA-LE，BBS，下肢徒手肌力测试，静态平衡能力	提高下肢协调和运动功能，改善下肢肌力
Wang等^[34](2012)	—	62.98±10.88	> 6个月	RCT	健侧下肢皮质运动区	每次10 min，每天1次，每周5 d，共2周	1	“8”字形	90%	MEP，FMA-LE，步态分析	运动控制和行走能力改善
Naghdi等^[35](2015)	6/1	42~78	> 6个月	前后测试验	健侧下肢皮质运动区	每次20 min，每天1次，共5 d	1	“8”字形	100%	MAS，H反射，MEP，FMA-LE，TUGT	肌张力降低，运动功能改善
Kim等^[36](2014)	32/0	> 18	< 3个月	RCT	健侧小脑	每次15 min，每天1次，共5 d，	1	“8”字形	100%	10MWT，BBS	10MWT、BBS均明显改善

References 47

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纳入文献	纳入条件	随机分配	分配隐藏	基线相似	受试者	干预人员	评估人员	完成实验	干预意向	统计结果	测量值	总分
Kakuda等^[16](2013)	√			√	√		√	√	√	√	√	7
杨露等^[17](2016)	√	√		√	√		√	√	√	√	√	8
Cha等^[18](2017)	√	√	√	√	√	√	√		√	√	√	9
Chieffo等^[19](2021)	√			√	√		√	√	√	√	√	7
Ji等^[20](2016)	√	√	√	√			√	√	√	√	√	8
Chieffo等^[21](2014)	√	√	√	√	√		√	√	√	√	√	9
杨阳等^[22](2015)	√	√		√			√	√	√	√	√	7
Sasaki等^[23](2017)	√	√		√	√		√	√	√	√	√	8
Choi等^[24](2016)	√	√	√	√	√	√			√	√	√	8
Wang等^[25](2019)	√	√		√	√		√	√	√	√	√	8
Kakuda等^[26](2013)	√			√				√	√	√	√	5
Goh等^[27](2020)	√			√				√	√	√	√	5
Rastgoo等^[28](2016)	√	√		√	√				√	√	√	6
李亚梅等^[29](2016)	√	√		√			√	√	√	√	√	7
Huang等^[30](2018)	√	√		√	√		√	√	√	√	√	8
Lin等^[31](2015)	√	√		√	√		√	√	√	√	√	8
黄长耀等^[32](2018)	√	√		√	√		√	√	√	√	√	8
Forogh等^[33](2017)	√	√		√	√		√	√	√	√	√	8
Wang等^[34](2012)	√	√	√	√	√		√	√	√	√	√	9
Naghdi等^[35](2015)	√			√				√	√	√	√	5
Kim等^[36](2014)	√	√		√	√		√	√	√	√	√	8

Repetitive transcranial magnetic stimulation for lower limb dysfunction post stroke: a scoping review

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