Differential Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation Over Ipsilesional Primary Motor Cortex in Cortical and Subcortical Middle Cerebral Artery Stroke
Differential Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation Over Ipsilesional Primary Motor Cortex in Cortical and Subcortical Middle Cerebral Artery Stroke
复制标题
DOI：
10.1002/ana.21725
复制
发表时间：
2009-09-01
影响因子：
11.2
通讯作者：
Nowak, Dennis A.
中科院分区：
文献类型：
--
作者：
Ameli, Mitra;Grefkes, Christian;Nowak, Dennis A.
目的：促进同侧初级运动皮层（M1）的皮层兴奋性可能会改善中风后患手的灵活性。在皮层下或皮层卒中患者中，研究了10 Hz重复经颅磁刺激（rTMS）对同侧M1运动学和神经活动的影响。29例脑卒中后灵巧度受损患者（16例皮质下大脑中动脉[MCA]卒中，13例大脑中动脉（MCA）梗死累及皮层下组织和原发或继发皮层感觉运动区，接受10Hz rTMS治疗（5秒刺激，25秒中断，1，000个脉冲，静息运动阈值的80%）施加于：1）同病灶M1和2）顶点（对照刺激）。对于行为测试，29名患者在每次rTMS应用之前和之后用受影响和未受影响的手进行食指和手敲击运动。对于功能磁共振成像，18例患者进行食指轻敲运动与受影响的和未受影响的手之前和之后，每个rTMS application.Results：10 Hz的rTMS在同病灶M1，但不超过顶点，改善运动动力学在14 16例皮质下中风，但没有在额外的皮质中风患者。10 Hz rTMS轻微恶化的灵巧性的受影响的手在13例皮质卒中患者中的7例。在神经水平上，rTMS在同病灶M1减少了11例皮质下卒中患者的对侧病灶M1的神经活动，但在7例皮质卒中患者中引起了广泛的初级和次级运动区的双侧募集。活动在同病灶M1在基线与改善食指敲击频率诱导rTMS.Interpretation：10 Hz rTMS的有益影响，在同病灶M1对运动功能的影响手依赖于MCA中风的扩展。同病灶M1的神经活动可以作为易化rTMS有效性的替代标记。
Objective: Facilitation of cortical excitability of the ipsilesional primary motor cortex (M1) may improve dexterity of the affected hand after stroke. The effects of 10Hz repetitive transcranial magnetic stimulation (rTMS) over ipsilesional M1 on movement kinematics and neural activity were examined in patients with subcortical or cortical stroke.Methods: Twenty-nine patients with impaired dexterity after stroke (16 subcortical middle cerebral artery [MCA] strokes, 13 MCA strokes involving subcortical tissue and primary or secondary cortical sensorimotor areas) received I session of 10Hz rTMS (5-second stimulation, 25-second break, 1,000 pulses, 80% of the resting motor threshold) applied over: 1) ipsilesional M1 and 2) vertex (control stimulation). For behavioral testing, 29 patients performed index finger and hand tapping movements with the affected and unaffected hand prior to and following each rTMS application. For functional magnetic resonance imaging, 18 patients performed index finger tapping movements with the affected and unaffected hand before and after each rTMS application.Results: Ten-Hz rTMS over ipsilesional M1, but not over vertex, improved movement kinematics in 14 of 16 patients with subcortical stroke, but not in patients with additional cortical stroke. Ten-Hz rTMS slightly deteriorated dexterity of the affected hand in 7 of 13 cortical stroke patients. At a neural level, rTMS over ipsilesional M1 reduced neural activity of the contralesional M1 in 11 patients with subcortical stroke, but caused a widespread bilateral recruitment of primary and secondary motor areas in 7 patients with cortical stroke. Activity in ipsilesional M1 at baseline correlated with improvement of index finger tapping frequency induced by rTMS.Interpretation: The beneficial effects of 10Hz rTMS over ipsilesional M1 on motor function of the affected hand depend on the extension of MCA stroke. Neural activity in ipsilesional M1 may serve as a surrogate marker for the effectiveness of facilitatory rTMS.