经颅磁刺激在脑梗死患者运动功能康复中的效果

目的　探讨经颅磁刺激 (TMS)在促进脑梗死运动功能康复中的作用。方法　在基本治疗相同的情况下 ,将TMS康复治疗的脑梗死患者分组比较 ,观察FMA评分、Barthel指数评分 ,进行临床疗效比较。结果　经TMS治疗后的康复组 6 3例 (有效率 90 5 % )明显优于对照组 6 0例 (有效率6 8 3% ) ;TMS康复治疗对 75岁以下患者有效 (P <0 0 0 1) ,对 75岁以上患者疗效趋向不显著 (P >0 0 5 ) ;发病 3个月内组经TMS治疗后的FMA评分为 5 9 0± 2 2 8,发病 3个月后进行TMS康复治疗组治疗后的FMA评分为 4 5 4± 14 8,发病 3个月内尽早康复治疗优于发病 3个月后进行TMS康复治疗组。结论　TMS康复运动功能疗效肯定 ,且其康复疗效受年龄影响 ,尽早TMS治疗有益于患者的康复

Effect of transcranial magnetic stimulation on rehabilitation of motor function in patients with cerebral infarction

OBJECTIVE: To study the effect of transcranial magnetic stimulation (TMS) on the rehabilitation of motor function in patients with cerebral infarction. METHODS: Two hundred twenty and three patients with the initial attack of cerebral infarction were divided into three groups. (1) One hundred twenty and three patients were randomly further divided into rehabilitation subgroup (n = 63, aged 64.0 +/- 7.9, treated with TMS beginning from the 6 approximately 10 th day after onset) and control subgroup (n = 60, aged 63.5 +/- 7.9). (2) Sixty patients were divided into three subgroups according to the age: 35 approximately 55 (n = 11), 56 approximately 75 (n = 20), and over 76 (n = 30). (3) Forty patients aged 56 approximately 75 were further divided into two subgroups according to the timing of beginning of TMS: subgroup with TMS beginning within 3 months after the initial attack (n = 20) and subgroup with TMS beginning 3 months after the initial attack (n = 20). Except for TMS, the basic treatment was the same for all of the patients. TMS was given once a day for 14 days. Fugl-Meyer score, Barthel index, and central spinal cord motor conduction time (CMCT) were measured twice: just before treatment and after the 14th treatment. A difference less than 20 ms between CMCT values measured before and after TMS and failure to induce CMCT both before and after TMS were regarded as ineffective hess, and a difference more than 20 ms between CMCT values measured before and after TMS and a change from failure to induce CMCT were regarded as effective hess. RESULTS: The effective rate was 90.5% in the rehabilitation subgroup and 68.3% in the control group (P < 0.05). The Fugl-Meyer scores were 36.3 +/- 15.8 and 33.7 +/- 13.7 in the rehabilitation subgroup and control subgroup before treatment respectively (P > 0.05), and were 51.7 +/- 15.7 and 40.0 +/- 13.9 after treatment respectively (P < 0.01). The Barthel index were 39.6 +/- 15.8 and 40.0 +/- 14.9 in the two subgroups before treatment respectively (P > 0.05) and were 50.5 +/- 15.7 and 43.9 +/- 15.3 after treatment respectively (P < 0.05). The Fugl-Meyer scores before and after TMS were 35.8 +/- 11.3 and 61.6 +/- 18.6 in the subgroup aged 35 approximately 55 (P < 0.01), 33.5 +/- 14.0 and 49.2 +/- 16.0 in the subgroup aged 56 approximately 75 (P < 0.001), and 32.1 +/- 10.7 and 37.6 +/- 11.3 in the subgroup aged over 75 (P > 0.05). The Fugl-Meyer scores were 41.2 +/- 15.7 and 59.0 +/- 22.8 before and after TCM respectively in the subgroup with early TMS treatment (P < 0.01), and were 34.3 +/- 13.5 and 45.4 +/- 14.8 respectively in the subgroup with TMS beginning 3 months after the onset (P < 0.05). CONCLUSION: TMS is effective on the rehabilitation of motor function in patients with cerebral infarction. The effectiveness of TMS treatment depends on the age of the patients and timing of beginning treatment.