高频重复经颅磁刺激对缺血性脑卒中后中枢性面瘫的效果北大核心CSCD

目的探讨高频重复经颅磁刺激(rTMS)在缺血性脑卒中后中枢性面瘫中的应用价值。方法 2020年6月至2021年6月,选取在徐州市中心医院康复科住院的脑卒中后中枢性面瘫患者54例,随机分为对照组(n=27)和试验组(n=27)。两组均给予常规康复治疗,包括药物治疗和面部肌群康复训练。试验组加患侧初级运动皮质5 Hz rTMS治疗,对照组在同一治疗部位予以相同参数的假刺激治疗。治疗前、治疗4周后分别采用修订版House-Brackmann分级系统(HBGS-2)、Sunnybrook面部分级量表、静息时双侧嘴角至人中下中心点的水平距离差、最大努力示齿时双侧嘴角至下颌中切牙交点的水平距离差和伸舌时舌中线偏离面部正中线的角度对患者进行面神经功能评价。结果两组各脱落1例。治疗前,两组HBGS-2评分、Sunnybrook面部分级量表评分、静息时双侧嘴角至人中下中心点的水平距离差、最大努力示齿时双侧嘴角至下颌中切牙交点的水平距离差和伸舌时舌中线偏离面部正中线的角度均无显著性差异(P>0.05);治疗后两组各项评价指标均显著改善(|t|>8.987, P<0.001),且试验组均明显优于对照组(t>2.939, P<0.01)。结论患侧初级运动皮质5 Hz rTMS对改善缺血性脑卒中后中枢性面瘫患者面神经功能有积极作用。

Effects of high-frequency repetitive transcranial magnetic stimulation on central facial paralysis after ischemic stroke

Objective To explore the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS) on central facial paralysis after ischemic stroke.Methods From June,2020 to June,2021,54 patients with central facial palsy after ischemic stroke who were hospitalized in the Rehabilitation Department of Xuzhou Central Hospital were randomly divided into control group(n =27) and experimental group(n = 27).Both groups were given conventional rehabilitation treatment,including medication and facial muscle rehabilitation training.The experimental group was treated with 5 Hz rTMS on the affected primary motor cortex,and the control group was treated with the same parameters of sham stimulation at the same site.Before treatment and four weeks after treatment,the House-Brackmann Grading System 2.0(HBGS-2),the Sunnybrook Facial Grading System,the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest,the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out were used to evaluate the facial nerve function of the patient.Results One case dropped down in each group.Before treatment,there was no significant difference in the scores of HBGS-2 and Sunnybrook Facial Grading System,the horizontal distance difference between the bilateral mouth corners to the lower center of the philtrum at rest,the horizontal distance difference between the bilateral mouth corners to the intersection of the mandibular central incisor when showing the teeth at the best effort,and the angle of the tongue midline deviating from the facial midline when the tongue was stretched out between two groups(P > 0.05).After treatment,all the indexes significantly improved in both groups(|t| > 8.987,P < 0.001),and were better in the experimental group than in the control group(t > 2.939,P < 0.01).Conclusion 5 Hz rTMS on the affected primary motor cortex is effective on the facial nerve function of patients with central facial palsy after ischemic stroke.