重复经颅磁刺激提高脑卒中后上肢功能靶点选择和定位的应用进展  

Progress of the Target Selection and Localization of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Function after Stroke

作　　者：刘灿欢 沈滢[1,2] 戴文骏 郭川[1] 程怡慧[1] 朱奕 王彤[1] LIU Canhuan;SHEN Ying;DAI Wenjun;GUO Chuan;CHENG Yihui;ZHU Yi;WANG Tong(The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu 210029,China;School of Rehabilitation Medicine,Nanjing Medical University,Nanjing,Jiangsu 210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏南京210029 [2]南京医科大学康复医学院,江苏南京210029

出　　处：《康复学报》2024年第3期294-303,共10页Rehabilitation Medicine

基　　金：国家重点研发计划项目(2022YFC2009700);江苏省重点研发计划产业前瞻与关键核心技术竞争项目(BE2023034)。

摘　　要：脑卒中是一种常见的脑血管疾病,具有高发病率、高死亡率、高致残率、高复发率等特点,给我国的社会经济带来了严重负担。脑卒中后约30%~60%的患者遗留有不同程度的上肢运动功能障碍。目前国内外改善脑卒中后上肢运动功能的康复技术主要为运动功能训练,而重复经颅磁刺激(rTMS)因为能够通过调节皮层兴奋性和诱导神经可塑性来促进脑卒中患者的上肢运动功能恢复,在脑卒中康复中的应用逐渐增多,已被指南列入A级推荐。但是相关临床研究还存在较大异质性,治疗效果受到靶点选择不同以及靶点定位准确性等因素影响。近年来关于新的刺激靶点及不同定位方法的研究逐渐增加,本文对rTMS作用于初级运动皮层(M1区)、前运动皮层(PMC)等脑区的rTMS方案、疗效、作用机制及刺激靶点的定位方法进行综述,旨在为rTMS在脑卒中后上肢运动功能康复的临床应用提供指导。Stroke is a common cerebrovascular disease with high morbidity,mortality,disability,and recurrence imposing sig‐nificant social and economic burdens.Following a stroke,approximately 30%-60%of patients experience varying degrees of upper limb motor dysfunction.Currently,rehabilitation techniques for improving post-stroke upper limb motor function,both domestically and internationally,primarily involve motor function training.Repetitive transcranial magnetic stimulation(rTMS),because it can enhance upper limb motor function recovery by modulating cortical excitability and promoting neuroplasticity,has been increas‐ingly used in stroke rehabilitation and has been included in the guideline as a grade A recommendation.However,there is still large heterogeneity in the relevant clinical studies,and the therapeutic effect is affected by factors such as different target selection and tar‐get localization accuracy.In recent years,the number of studies on new stimulation targets and different localization methods has been increasing.In this paper,we review the protocols,efficacy,mechanism of action,and localization of stimulation targets of rTMS in the primary motor cortex(MI),premotor cortex(PMC),and other brain regions,aiming to provide guidance for the clinical applica‐tion of rTMS in the rehabilitation of upper limb motor function after stroke.

关 键 词：脑卒中 经颅磁刺激 刺激靶点 上肢运动功能 康复 

分 类 号：R743.3[医药卫生—神经病学与精神病学]