fMRI指导下rTMS对脑梗死后运动功能恢复的促进

【目的】探讨fMRI指导下的重复经颅磁刺激（repetitivetranscranialmagneticstimulation，rTMS）对脑梗死患者运动功能康复的作用。【方法】选取急性期右侧放射冠区脑梗死患者50例，男28例，女22例，随机分为5组，每组lO例，所有患者均接受改善循环、营养神经等同样的基础治疗方案。治疗组rTMS治疗前、后及90d时接受Fugl—Meyerscale（FMA）评定手运动功能，同时各组患者还分别进行NIHss（nationalinstituteofhealthstrokescale）和BI（barthelindex）评分来评价其整体神经功能缺损情况和日常生活能力情况。对照组在入院时、14d时及90d时也进行FMA、NIHSS、BI评分。【结果】各组于治疗14d及90d时FMA，BI评分与治疗前比较有显著性差异（P〈0．05），NIHSS评分在90d时与治疗前比较有显著性差异（P〈0．05）。【结论】fMRI指导下的低频rTMS刺激健侧大脑半球的M1区对脑梗死患者的早期手运动功能恢复有促进作用，对患者的整体神经功能和日常生活能力有远期的治疗效果。

Clinical study on rTMS facilitating motor functions recovery under the guidance of fMRI in cerebral infarction patients

Objective] To explore the therapeutic effects of repetitive transcranial magnetic stimulation （rTMS） guided by fMRI on rehabilitation of motor functions in patients after cerebral infarction. Methods] fifty patients （28 males and 22 females with acute cerebral infarction of righl corona radiate were selected. They were randomly allocated into 5 groups（10 in each group）. All subjects accepted the same basic therapy. Hotor function of the affeced hand of patient in the treatment groups （group A-D） was evaluated with Fugl-Meyer scale （FMA） before and after r7MS and 90 days later. General status of neurological deficiency and activities of daily living of all patients were assessed with National Institute of Health stroke scale （NIHSS） and Barthel index （BI）. Results ] The FMA and BI of all treated groups 14d and 90d after treatment were significantly different as compared with before treatment（P 〈 0.05）. The NIHSS of 90d were significant different as compared with before treatment（P〈 0.05）. Conclusion] Stimulating the contralateral M1 area with rTMS under the guidance of fMRI may improve the hand motor function, recover the neurological deficiency and activity of daily living of the patients with cerebral infarction.