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

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。

Effect of high frequency and low frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke spasticity: A comparative study

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.