高低频重复经颅磁刺激治疗卒中后上肢痉挛的对照研究

摘要

Objective To investigate the clinical efficacy and differences of repetitive transcranial magnetic stimulation (rTMS) for high-frequency and low-frequency stimulation in the treatment of stroke upper limb spasticity. Methods A total of 60 patients from department of neurology and physiotherapy with spasticity were randomized to receive 10 Hz (n=20), 1 Hz (n=20) or sham (n=20) rTMS. The high-frequency rTMS group and the low-frequency rTMS group were given rTMS for 40 days in the ipsilesional and contralesional primary motor cortex. The stimulation frequency of the high-frequency rTMS was 10 Hz and the stimulation intensity was 80% motor threshold (MT). The stimulation frequency of the low-frequency rTMS was 1 Hz, 90% MT; the sham stimulation group received sham stimulation. All of participants received conventional rehabilitation. All the treatments were performed once a day, 5 times per week, and continued for 8 weeks. The modified Ashworth scale (MAS), upper extremities motor function test of Fugl-Meyer movement assessment (U-FMA) and modified Barthel index (MBI) were performed before and 8 weeks after treatment. Results After treatment, there was a significant improvement of MAS U-FMA and MBI scores after treatment in three groups (P<0.01). The MAS,U-FMA and MBI scores of the low-frequency group and high-frequency group were more obviously improved than that of the control group (P<0.05), but there was no significant difference between the low frequency group and the high frequency group (P>0.05). Conclusion Low-frequency stimulation of the contralesional and high-frequency stimulation of the ipsilesional M1 area can both effectively improve the clinical symptoms and motor function of the spastic patients. There was no significant difference for their clinical efficacy.%目的 探讨高、低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)大脑初级运动皮层(M1区)治疗卒中后上肢痉挛的临床疗效及差异.方法 纳入我院神经内科和中医理疗科卒中后痉挛性偏瘫患者60例,随机分为高频rTMS组、低频rTMS组和假刺激组各20例.高频rTMS组刺激患侧M1区,刺激频率为10 Hz,刺激强度为80%运动阈值;低频rTMS组刺激健侧M1区,刺激频率为1 Hz,刺激强度为90%运动阈值;假刺激组接受相同噪声与时间的假刺激治疗.所有患者均接受常规康复治疗.各组患者分别在治疗前及治疗8周后采用改良Ashworth痉挛评定量表(modified Ashworth scale,MAS)、Fugl-Meyer运动功能评定量表中上肢运动功能测试部分(upper extremities motor function test of Fugl-Meyer movement assessment,U-FMA)和改良Barthel指数(modified Barthel index,MBI)进行评定.以上治疗均1次/日,5次/周,连续治疗8周.结果 与治疗前相比,治疗后三组患者上肢MAS、U-FMA和MBI评分均有显著改善,差异均有统计学意义(P<0.01);治疗后,高频rTMS组和低频rTMS组比假刺激组的上肢MAS、U-FMA和MBI评分改善更明显,比较差异有统计学意义(P<0.05);但低频rTMS组和高频rTMS组上肢MAS、U-FMA和MBI评分比较,差异无统计学意义.结论 健侧低频与患侧高频rTMS刺激大脑M1区均可有效改善患者的临床症状和运动功能障碍.两种经颅磁刺激方案临床疗效相当.