首页|不同治疗时程的重复经颅磁刺激对脑卒中患者上肢运动功能及脑功能连接的影响

不同治疗时程的重复经颅磁刺激对脑卒中患者上肢运动功能及脑功能连接的影响

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目的:以非受累侧前运动皮质区(premotor cortex,PMC)为刺激靶点,比较不同治疗时程的重复经颅磁刺激(re-peated transcranial magnetic stimulation,rTMS)对脑卒中患者上肢运动功能及脑功能连接的影响.方法:将60例缺血性脑卒中后上肢运动功能障碍患者随机分到6周rTMS组、4周rTMS组和2周rTMS组以及对照组,每组15例.在治疗前后采用上肢Brunnstrom分期、Fugl-Meyer运动功能评分上肢部分(Fugl-Meyer assessment of upper extremity,FMA-UE)和Wolf运动功能评分(Wolf motor function test,WMFT)进行行为学评定,另外以非受累侧PMC为种子点采用静息态功能磁共振成像(resting state functional magnetic resonance imaging,rs-fM-RI)进行功能连接分析.结果:治疗后,2周rTMS组的FMA-UE和WMFT的评分与4周及6周rTMS组间有显著性差异(P＜0.05),但4周rT-MS 组的 FMA-UE和WMFT的评分与6周rTMS组间无显著性差异(P＞0.05).非受累侧PMC区为种子点的功能连接分析显示,rTMS治疗后非受累侧PMC与同侧中央前回、对侧颞中回和楔前叶功能连接增强(P＜0.05).结论:研究结果表明,以非受累侧半球PMC为靶点的低频rTMS治疗可有效促进偏瘫上肢运动功能的恢复,其中与2周rTMS干预和6周rTMS干预相比,4周rTMS干预具有最佳的时间-效益比,这可能与其增强双侧半球间、非受累半球内皮质-皮质间的功能连接有关.
Effects of low frequency repetitive transcranial magnetic stimulation at different stimulating sessions on upper limb motor function and brain functional connectivity in stroke patients
Objective:To explore the effects of repeated transcranial magnetic stimulation(rTMS)at different stimulating sessions on upper limb motor function and brain functional connectivity in stroke patients,targeting on stimu-late the contralateral premotor cortex(PMC).Method:Sixty patients with upper limb motor dysfunction after ischemic stroke were randomly assigned to 6-week rTMS group,4-week rTMS group,2-week rTMS group or control group,each with 15 participants.Up-per limb Brunnstrom stage,Fugl-Meyer assessment for upper extremity(FMA-UE)and Wolf motor function test(WMFT)were assessed before and after treatment to evaluate behavioral outcomes.The functional connec-tivity was analyzed by resting state functional magnetic resonance imaging(rs-fMRI)with the contralateral PMC as the seed point.Result:After treatment,the FMA-UE and WMFT scores of the 2-week rTMS group were significantly differ-ent from those of the 4-week and 6-week rTMS groups(P＜0.05),but there was no significant difference be-tween the 4-week rTMS group and the 6-week rTMS group(P＞0.05).Functional connectivity analysis using contralateral PMC as a seed point showed that functional connections were enhanced between contralateral PMC and ipsilateral anterior central gyrus,as well as the contralateral middle temporal gyrus and precuneus af-ter rTMS treatment(P＜0.05).Conclusion:The 4-week rTMS group has the best duration-benefit compared with the 2-week rTMS group and the 6-week rTMS group.The probable mechanism was related to that rTMS treatment could reduce the ef-fect of interhemispheric inhibition on motor cortex,and then enhance the cortico-cortical functional connectivi-ty in the contralateral hemisphere effectively,resulting in the recovery of upper limb motor function.

repetitive transcranial magnetic stimulationischemic strokeupper limb motor functionpremotor cortexfunctional connectivity

彭源、张熙斌、梅伟文、吕艺宸、赵悦涵、潘瑶、张爱华、周洪雨、王奎、王鑫

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广州市第一人民医院康复医学科,广东省广州市,510180

扬州大学临床医学院康复医学科

广州市老人院老年康复中心

滨州医学院康复医学院

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重复经颅刺激 缺血性脑卒中 上肢运动功能 前运动皮质区 功能连接

国家自然科学基金项目江苏省高层次卫生人才"六个一工程"拔尖人才项目扬州市科技局国际科技合作项目广州市科技计划项目

82072533LGY2018027YZ2022203202102080079

2024

10.3969/j.issn.1001-1242.2024.10.005

中国康复医学杂志
中国康复医学会

中国康复医学杂志

CSTPCD北大核心
影响因子：2.026
ISSN：1001-1242
年,卷(期)：2024.39(10)