高频与低频重复经颅磁刺激对脑卒中后肌痉挛的改善效果比较

doi:10.3969/j.issn.1004-583X.2022.05.007

摘要/Abstract

摘要：

目的探讨高频和低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)治疗脑卒中后肌痉挛的临床效果。方法 54例诊断为脑卒中后肌痉挛患者随机分成3组(每组18例):高频组、低频组和对照组。所有患者均常规给予脑卒中后二级预防用药结合康复训练治疗4周,其中高频组给予患侧高频rTMS治疗,低频组给予健侧低频rTMS治疗,对照组不接受rTMS。分别于治疗前后进行评定,通过比较患侧屈腕肌的运动诱发电位(MEP)潜伏期、中枢运动传导时间(CMCT)、上肢Fugl-Meyer运动功能量表(FMA)评分及改良Ashworth痉挛量表(MAS)评分、临床痉挛指数(CSI)、改良Barthel指数(MBI)判定治疗效果。结果 3组治疗前相关指标检测差异无统计学意义(P>0.05)。治疗后,3组上肢FMA评分、MBI评分显著升高,而屈腕MAS、CSI指数、MEP潜伏期和CMCT时间显著降低,差异有统计学意义(P<0.05)。高频组和低频组FMA评分、MBI评分均高于对照组,屈腕MAS、CSI指数、MEP潜伏期和CMCT时间均低于对照组,以高频组更为明显,差异均具有统计学意义(P<0.05) 。结论患侧高频和健侧低频rTMS均可安全、有效治疗脑卒中后肌痉挛,改善上肢运动功能,且患侧高频rTMS治疗效果优于健侧低频rTMS。

关键词: 重复经颅磁刺激, 脑卒中, 肌痉挛, 频率

Abstract:

Objective To compare the clinical effect between high frequency and low frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke spasticity. Methods Totally 54 post-stroke spasticity patients were randomely divided into the high frequency group (n=18), the low frequency group (n=18) and the control group (n=18). In addition of 4-week routine treatment (secondary prevention medications+rehabilitation training), the high frequency group were additionally treated with high-frequency rTMS on the affected side, the low frequency group additionally with low-frequency rTMS on the healthy side. The control group did not receive rTMS. The effect assessment was conducted before and after treatment. The therapeutic effect was determined by comparing the motor evoked potentials (MEP) latency of wrist flexor muscles on the affected side, central motor conduction time (CMCT), Fugl-Meyer assessment (FMA) of upper extremity (FMA-UE), Modified Ashworth Scale (MAS), clinical spasticity index (CSI), Modified Barthel Index (MBI).Results The difference was not statistically significant in the related indicators among the three groups before treatment (P>0.05). After treatment, FMA-UE, MBI score in groups were significantly increased, while wrist flexor MAS, CSI, MEP latency, CMCT were apparently decreased (P<0.05). Among the three groups, FMA, MBI were remarkably increased in the frequency groups than in the cortrol group, and wrist flexor MAS, CSI, MEP latency, CMCT were obviously decreased when compared with the cortrol group (P<0.05), the high frequency group was more prevalent (P<0.05). Conclusion For post-stroke spasticity patients, both the high frequency rTMS on the affected side and the low-frequency rTMS on the healthy side can relieve post-stroke spasticity and elevate the FMA-UE score, which is safe and effective. And the high frequency rTMS on the affected side is better than low frequency rTMS on the healthy side.

Key words: repetitive transcranial magnetic stimulation, stroke, spasticity, frequency

中图分类号:

R741.04

夏菁, 陈缪存, 林敏, 郝又国. 高频与低频重复经颅磁刺激对脑卒中后肌痉挛的改善效果比较[J]. 临床荟萃, 2022, 37(5): 427-430.

Xia Jing, Chen Miaocun, Lin Min, Hao Youguo. Effect of high frequency and low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke spasticity: A comparative study[J]. Clinical Focus, 2022, 37(5): 427-430.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.05.007

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I5/427

图/表 3

参考文献 18

[1]	GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: A systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet Neurol, 2019, 18(5): 439-458. doi: 10.1016/S1474-4422(19)30034-1 URL
[2]	Marini M, Banaji MR, Pascual-Leone A. Studying implicit social cognition with noninvasive brain stimulation[J]. Trends Cogn Sci, 2018, 22(11):1050-1066. doi: 10.1016/j.tics.2018.07.014 URL
[3]	许毅, 李达, 谭立文, 等. 重复经颅磁刺激治疗专家共识[J]. 转化医学杂志, 2018, 7(1):4-9.
[4]	Lefaucheur JP, Aleman A, Baeken C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation(rTMS): An update(2014-2018)[J]. Clin Neurophysiol, 2020, 131(2): 474-528. doi: 10.1016/j.clinph.2019.11.002 URL
[5]	邓丽娟, 吴晓华, 许美珍. 高频重复经颅磁刺激联合任务导向性训练对脑卒中患者手功能康复的疗效[J]. 中国处方药, 2019, 17(3):132-134.
[6]	上海市医学会脑电图与临床神经生理专科分会. 重复经颅磁刺激的临床应用与操作规范上海专家共识[J]. 上海医药, 2022, 45(2):65-70.
[7]	张力新, 常美榕, 王仲朋, 等. 基于经颅电、磁刺激神经调控方法的卒中康复研究进展[J]. 北京生物医学工程, 2021, 40(2):191-197.
[8]	邵迪, 罗海彦. 重复经颅磁刺激治疗脑梗死后偏瘫的研究进展[J]. 临床神经病学杂志, 2019, 32(5):394-397.
[9]	Mazurek KA, Schieber MH. Mirror neurons precede non-mirror neurons during action execution[J]. J Neurophysiol, 2019, 122(6):2630-2635. doi: 10.1152/jn.00653.2019 pmid: 31693444
[10]	韩茜茜, 徐宁, 王秀秀, 等. 强制性运动疗法联合重复经颅磁刺激对脑卒中患者上肢运动功能的影响[J]. 中华物理医学与康复杂志, 2020, 42(12):1067-1071.
[11]	Farinelli M, Cevolani D, Gestieri L, et al. Brain and behaviour in post-acute stroke: Reduction in seeking and posterior cingulate neuronal variability[J]. J Clin Exp Neuropsychol, 2020, 42(6): 584-601. doi: 10.1080/13803395.2020.1780417 pmid: 32605471
[12]	孔培培, 陈颖, 翟清华, 等. 低频rTMS联合作业疗法在缺血性脑卒中恢复期中的应用[J]. 中国实用神经疾病杂志, 2019, 22(3):238-245.
[13]	窦佳鸣, 李春光, 眭演祥, 等. 重复经颅磁刺激对脑卒中后上肢功能影响的近红外脑功能成像研究[J]. 中华物理医学与康复杂志, 2019, 41(6);418-423.
[14]	孙雷, 张健. 重复经颅刺激用于脑卒中后康复的研究进展[J]. 中国医疗器械信息, 2020, 26(5):42-43.
[15]	张英, 廖维靖, 郝赤子. 低频重复经颅磁刺激联合作业治疗对脑卒中患者上肢运动功能恢复的临床研究[J]. 中国康复, 2019, 34(3):142-145.
[16]	Sasaki N, Mizutani S, Kakuda W, et al. Comparison of the effects of high-and low-frequency repetitive transcranial magnetic stimulation on upper limb hemiparesis in the early phase of stroke[J]. J Stroke Cerebrovasc Dis, 2013, 22(4): 413-418. doi: 10.1016/j.jstrokecerebrovasdis.2011.10.004 URL
[17]	干峥, 缪永娟, 沈显山, 等. 1 Hz重复经颅磁刺激对脑卒中偏瘫病人上肢功能的疗效研究[J]. 安徽医药, 2020, 24(12):2377-2382.
[18]	Sasaki N, Kakuda W, Abo M. Bilateral high- and low-frequency rTMS in acute stroke patients with hemiparesis: A comparative study with unilateral high-frequency rTMS[J]. Brain Inj, 2014, 28(13-14):1682-1686. doi: 10.3109/02699052.2014.947626 URL

组别	例数	年龄 (岁)	性别 (男/女)	身高 (cm)	病程 (d)
高频组	18	69.1±1.9	10/8	170.2±1.6	76.5±35.7
低频组	18	70.4±2.1	11/7	169.3±1.7	78.2±37.5
对照组	18	69.6±1.7	10/8	169.2±1.6	74.1±33.9
χ²/F值		2.13	0.16	2.05	0.06
P值		0.13	0.93	0.14	0.95

组别	例数	年龄 (岁)	性别 (男/女)	身高 (cm)	病程 (d)
高频组	18	69.1±1.9	10/8	170.2±1.6	76.5±35.7
低频组	18	70.4±2.1	11/7	169.3±1.7	78.2±37.5
对照组	18	69.6±1.7	10/8	169.2±1.6	74.1±33.9
χ²/F值		2.13	0.16	2.05	0.06
P值		0.13	0.93	0.14	0.95

组别	例数	上肢FMA		屈腕MAS		CSI指数		MBI评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
高频组	18	30.24±3.01	37.98±3.79^*#△	2.24±0.16	1.70±0.11^*#△	12.55±0.54	10.46±0.41^*#△	36.99±3.71	46.53±4.18^#△
低频组	18	29.73±3.03	36.12±3.38^#△	2.17±0.13	1.84±0.13^#△	12.44±0.49	10.89±0.48^#△	36.77±3.57	43.52±3.96^#△
对照组	18	30.67±3.31	33.41±3.24^△	2.23±0.15	2.01±0.14^△	12.52±0.59	11.67±0.51^△	37.28±3.91	41.69±4.01^△
F值		0.41	8.96	1.19	26.78	0.20	30.85	0.09	7.33
P值		0.67	0.0005	0.32	<0.01	0.82	<0.01	0.92	0.0016

组别	例数	上肢FMA		屈腕MAS		CSI指数		MBI评分
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
高频组	18	30.24±3.01	37.98±3.79^*#△	2.24±0.16	1.70±0.11^*#△	12.55±0.54	10.46±0.41^*#△	36.99±3.71	46.53±4.18^#△
低频组	18	29.73±3.03	36.12±3.38^#△	2.17±0.13	1.84±0.13^#△	12.44±0.49	10.89±0.48^#△	36.77±3.57	43.52±3.96^#△
对照组	18	30.67±3.31	33.41±3.24^△	2.23±0.15	2.01±0.14^△	12.52±0.59	11.67±0.51^△	37.28±3.91	41.69±4.01^△
F值		0.41	8.96	1.19	26.78	0.20	30.85	0.09	7.33
P值		0.67	0.0005	0.32	<0.01	0.82	<0.01	0.92	0.0016

组别	例数	MEP潜伏期		CMCT
组别	例数	治疗前	治疗后	治疗前	治疗后
高频组	18	34.94±2.72	29.65±2.61^*#△	16.58±1.98	12.57±1.66^*#△
低频组	18	35.23±2.87	31.60±3.05^#△	16.35±1.92	13.64±1.71^#△
对照组	18	35.54±2.85	33.62±2.81^△	16.80±1.95	15.53±1.79^△
F值		0.21	8.87	0.24	14.49
P值		0.81	0.0005	0.79	<0.01