连续性θ节律性磁刺激对卒中后疼痛病人皮层诱发电位的影响  

EFFCET OF CONTINUOUS THETA BURST STIMULATION ON MOTOR EVOKED POTENTIALS IN PATIENTS WITH CENTRAL POST-STROKE PAIN

作　　者：段强 黄肖群[1] 肖斌 袁华[2] 牟翔[2] 孙玮[2] DUAN Qiang;HUANG Xiao-Qun;XIAO Bin;YUAN Hu;MU Xiang;SUN Wei(Department of Rehabiliation Medicine,The People's Hospital of China Three Gorges University.The First People's Hospital of Yichang,Yichang 443000,China;Department of Physiotherapy and Rehabilitation,Xijing hospital,Fourth Military Medical University,Xi'an 710032,China)

机构地区：[1]三峡大学人民医院宜昌市第一人民医院康复医学科,宜昌443000 [2]陕西省西安市新城区第四军医大学西京医院康复理疗科,西安710032

出　　处：《中国疼痛医学杂志》2018年第10期743-747,共5页Chinese Journal of Pain Medicine

基　　金：科技部国际合作专项(DFA32610);陕西省国际合作项目(2015KW-035);军队创新工程(16CXZ022)

摘　　要：目的:中枢性卒中后疼痛(central post-stroke pain, CPSP)的发病率逐年增高,近年来,有研究者报道重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)治疗取得一定的效果,然而应用连续性θ节律性磁刺激(continuous theta burst stimulation, cTBS)的临床应用并不多见,且效果不明、机制不清。本研究拟采用作用于大脑M1区的c TBS观察CPSP病人大脑皮层运动诱发电位(motor evoked potentials, MEP)与短皮层内抑制/易化(short intracortical inhibition/intracortical facilitation, SICI/ICF)的变化,初步探讨其作用机制,并观察其临床疗效。方法:将18例卒中后伴有神经病理性痛的病人按照数字表法随机分为治疗组与对照组,每组各9例。两组病人均给予常规物理治疗和药物镇痛治疗,治疗组在此基础上给予cTBS治疗。分别在治疗前、治疗2周后进行MEP、SICI/ICF检测,同时采用VAS疼痛量表进行疼痛评估,并分析MEP、SICI/ICF的变化与VAS评分的相关性。结果:治疗2周后,两组病人VAS评分均有降低(P <0.01),与对照组相比,治疗组降低更明显(P <0.05);与治疗前相比,治疗组中MEP波幅和潜伏期均较治疗前明显改善(P <0.05),对照组也有变化,但无统计学意义;治疗组中短皮层内抑制(SICI),较治疗前明显降低(P <0.05),对照组也有变化,但无统计学意义;两组中皮层内易化(ICF)有改善趋势,但无统计学意义。进一步研究发现,VAS疼痛的改善程度与SICI呈正相关(r=0.7322,P=0.032)。结论:c TBS可以缓解卒中病人中枢性卒中后疼痛,且其疼痛改善的程度与SICI具有正相关性。Objective:The incidence of central post-stroke pain(CPSP)is increasing year by year.In recent years,repeated transcranial magnetic stimulation(rTMS)has been reported to have achieved certain results.However,the clinical application ofθrhythmic magnetic stimulation(continuous theta burst stimulation,cTBS)is rare,both the effects and mechanisms of cTBS are still unclear.In our study,we observed the influence of cTBS in the M1 area on the motor evoked potentials(MEP)and short intracortical inhibition/intracortical facilitaion(SICI/ICF)of patients with post-stroke pain.Methods:Eighteen patients with neuropathic pain after stroke were randomly divided into treatment group and control group with 9 cases each.All patients received the conventional physical therapy and the drug analgesic treatment for two weeks.The treatment group received the cTBS additionally.Before and 2 weeks after the treatment,the MEP,SICI/ICF were detected and the VAS score was assessed.The correlation between the changes of MEP,SICI/ICF and VAS score were analyzed.Results:Two weeks after treatment,the VAS score of both groups was decreased(P<0.01).Compared with the control group,the VAS score of the treatment group was decreased significantly(P<0.05).Compared with before treatment,the amplitudes and latencies of MEP were significantly improved in the treatment group(P<0.05).But the changes in the control group were not statistically significant(P>0.05).In the treatment group,compared with before treatment,the intracortical inhibition(SICI)after treatment was significantly decreased(P<0.05).However,in the control group,there was no statistical significance in the SICI before and after treatment.The intracortical facilitation(ICF)in both groups changed,however,there was no statistically significant difference between treatment groups.Furthermore,we found that the improved VAS score was positively correlated with the SICI(r=0.7322,P=0.032).Conclusions:The cTBS could relive pain in patients with post-stroke pain.Besides,the degree of pain relief was

关 键 词：连续性节律性磁刺激 中枢性卒中后疼痛 运动诱发电位 皮层内抑制 

分 类 号：R743.3[医药卫生—神经病学与精神病学]