低频重复经颅磁刺激治疗脑卒中患者上肢痉挛的临床研究

摘要

目的:观察低频重复经颅磁刺激(rTMS)对脑卒中患者上肢痉挛状态、运动功能的治疗效果.方法:将脑卒中恢复期上肢痉挛的患者40例随机分为真刺激组及假刺激组各20例.所有患者给予常规物理治疗,真刺激组给予低频重复经颅磁刺激(1Hz),作用于非患侧大脑M1区上肢投射区.假刺激组给予假刺激,作用部位与真刺激组相同.于治疗开始前,治疗4周结束时及治疗结束后2周随访时进行评估.评估内容包括改良Ashworth痉挛评定(MAS)、上肢Fugl-Meyer运动功能评定(ULFMA)、Barthel指数(BI)、运动诱发电位(MEP)和上肢F波潜伏时及波幅.结果:治疗后及随访时,真刺激组腕屈及肘屈MAS评分均较治疗前及同时间点假刺激组显著降低(均P<0.05),真刺激组ULFMA及BI评分较治疗前及同时间点假刺激组显著提高(均P<0.05),假刺激组MAS、ULFMA及BI评分治疗前后差异均无统计学意义.治疗后及随访时,真刺激组MEP潜伏时较治疗前及假刺激组显著缩短,波幅提高(均P<0.05),假刺激组治疗前后比较差异无统计学意义.治疗前后,F波在所有受试者均被引出,出波率100％.2组患者F波潜伏时、波幅组内及组间比较均无显著性差异.结论:低频重复经颅磁刺激可减轻脑卒中患者上肢痉挛,其作用机制可能与其提高了患侧大脑M1区上肢投射区的皮层兴奋性有关.%Objective: To observe the effects of the repetitive transcranial magnetic stimulation (rTMS) on spasticity and motor function of the patients with stroke. Methods: A total of 40 inpatients with stroke were randomly divided into treatment group and sham group. All patients received conventional rehabilitation intervention. In the treatment group, 20 patients received 1 Hz rTMS over the contralesional motor cortex (unaffected side), and 20 patients in sham group received sham stimulation. Two groups were treated once a day, 6 times a week, a total of 4 weeks of treatment. All outcomes were assessed at the beginning of the treatment (T0), at the end of the 4th-week treatment (T1) and at the end of the 2nd-week follow-up (T2). Both groups were assessed with Modified Ashworth Scale (MAS), Upper Limb Fugl-Meyer Assessment (ULFMA), Barthel Index (BI), Motor Evoked Potential (MEP) and upper limb F wave. Results: After treatment for 4 weeks, MAS scores were significantly decreased, and BI and ULFMA scores were significantly increased in the treatment group (P<0.05). Moreover, the effects lasted for more than 2 weeks after the end of the final intervention. The amplitude of MEP in treatment group was significantly higher than that in the sham group (P<0.05). But no significant difference was found in MEP at T2. There was no significant difference between the two groups in F wave amplitude and latency. Conclusion: Low frequency rTMS can decrease the upper limb spasticity of patients with stroke. The possible mechanisms might be related to the positive changes of the cortical excitability in affected hemisphere.