高低频重复经颅磁刺激治疗卒中后上肢痉挛的对照研究  

A Comparative Study of High and Low Frequency Repetitive Transcranial Magnetic Stimulation in Treatment of Upper Limb Spasticity after Stroke

作　　者：秦茵[1] 刘阅 郭小平 张长龙[1] 张寅鑫 吴基伟[1] 胡志宏[1] 刘敏华 郑颖 刘小英 QIN Yin;LIU Yue;GUO Xiao-Ping;ZHANG Chang-Long;ZHANG Yin-Xin;WU Ji-Wei;HU Zhi-Hong;LIU Min-Hua;ZHENG Ying;LIU Xiao-Ying.(Department of Physiotherapy, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, Chin)

机构地区：[1]南京军区福州总医院中医理疗科,福州350025

出　　处：《中国卒中杂志》2018年第6期550-555,共6页Chinese Journal of Stroke

基　　金：福建省科技厅社会发展引导性(重点)项目(2015Y0025)

摘　　要：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rT MS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。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 aftertreatment 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.

关 键 词：重复经颅磁刺激 卒中 上肢 痉挛 频率 

分 类 号：R743.3[医药卫生—神经病学与精神病学]