成对关联刺激与重复经颅磁刺激对大脑皮质兴奋性的调节作用  

Effects of paired associative stimulation and repetitive transcraniai magnetic stimulation on the excitability of the motor cortex

作　　者：随燕芳[1] 宋振华[2] 童良前[2] 杨露[1] 郭铁成[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院康复医学科,武汉430030 [2]中南大学湘雅医学院附属海口医院康复医学科

出　　处：《中华物理医学与康复杂志》2013年第7期547-551,共5页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的比较成对关联刺激（PAS）与重复经颅磁刺激（rTMS）对大脑皮质兴奋性的调节作用。 方法募集健康受试者10例。干预前检测所有受试者左侧大脑半球的运动诱发电位（MEP），记录其MEP波幅、MEP潜伏期和静息运动阈值（RMT）；次日相同时间点，给予左侧大脑半球及其对侧腕部正中神经频率为0.05 Hz、强度为120%RMT、刺激间隔（ISI）为10 ms（称为PAS10）、共90对脉冲的PAS干预，干预后1 min检测受试者左侧大脑半球MEP波幅、MEP潜伏期和RMT；间歇1周，以消除PAS10对受试者大脑皮质兴奋性的影响。在相同时间点给予同侧大脑半球频率为1 Hz、强度为120%RMT、共1000个脉冲的rTMS干预，干预后1 min检测受试者左侧大脑半球的上述指标。分别比较干预前、PAS10干预后1 min、rTMS干预后1 min上述各项指标的变化。 结果干预前10例受试者MEP波幅、MEP潜伏期和RMT分别为（2.93±0.99）mV、（20.97±1.67）ms和（46.06±5.32）%；PAS10干预后1 min分别为（1.14±0.76）mV、（21.87±1.09）ms和（52.06±4.20）%；rTMS干预后1 min分别为（2.24±0.79）mV、（20.88±1.94）ms和（49.00±4.54）%。PAS10干预后1 min的MEP波幅、MEP潜伏时、RMT与PAS10干预前的差值分别为（1.83±0.14）mV、（0.90±0.26）ms和（6.00±1.13）%；rTMS干预后与干预前的MEP波幅、MEP潜伏期、RMT差值分别为（0.69±0.10）mV、（0.09±0.05）ms和（3.94±0.93）%。rTMS干预后1 min与干预前比较，MEP波幅降低、RMT增大（P〈0.01），而MEP潜伏期无明显变化（P＆rt;0.05）；PAS10干预后1 min与干预前比较，MEP波幅降低、MEP潜伏期延长、RMT增大（P〈0.01）。PAS10干预后1 min与rTMS干预后1 min比较，MEP波幅、MEP潜伏期、RMT差异均有统计学意义（P〈0.01）。而且，PAS10干预前、后MEP波幅、MEP潜伏期、RMT差值与rTMS干预前、后MEP波幅、MEP潜伏期、RMT差值间比较，差异均有统计学意义（P〈0.01�Objective To compare the effects of paired associative stimulation （PAS） and repetitive transcranial magnetic stimulation （rTMS） on motor cortex excitability. Methods The baseline corticospinal excitability of the left hemispheres of 10 healthy subjects was measured in terms of resting motor threshold （RMT） and other indicators of motor evoked potentials （ MEP）. On the following day they received PAS composed of trascranial magnetic stimulation （TMS） to the motor cortex of the left hemisphere and electric stimulation （ES） of the median nerve contralateral to the motor cortex, with an interval of 10ms between the TMS and ES （termed PAS10）. The PAS10 was delivered at a frequency of 0.05 Hz and an intensity of 120% of the RMT, for a total of 90 pulses. The MEP amplitude, MEP latency and RMT were evaluated one minute after the stimulation. After the PAS intervention, an interval of one week was allowed to eliminate any effect of PAS on motor cortex excitability. Then rTMS was delivered to the subjects＇ left motor cortex at the same time of day at a frequency of 1 Hz and an intensity of 120% of the RMT, for a total of 1000 pulses. MEP amplitude, MEP latency and RMT were evaluated one minute after the stimulation. The two interventions were compared in terms of MEP amplitude, MEP latency and RMT. Results The average MEP amplitude, MEPlatency and RMT at baseline were （2.93 ±0.99）mV, （20.97 ± 1.67） ms, and （46.06 ± 5.32） % , respectively. One minute after PAS10, the MEP amplitude, MEP latency and RMT were （ 1.14 ± 0.76 ） mV, （21.87 ± 1.09 ） ms and （52.06 ± 4.20） % , respectively. One minute after rTMS, the MEP amplitude and la-tency and the RMT were （2.24 ± 0.79 ） mV, （20.88 ± 1.94） ms, and （49.00 ± 4.54） % , respectively. The differences in MEP amplitude, MEP latency and RMT pre- and post-intervention were （0.69 ± 0. 10 ） mV, （0.09 ± 0.05）msand （3.94±0.93）%, respectively forrTMS. ForPAS10 they were （1.83 ±0.14）mV, （0.90±0.2

关 键 词：经颅磁刺激 成对关联刺激 大脑皮质 

分 类 号：R74[医药卫生—神经病学与精神病学]