Combining Theta Burst Stimulation With Training After Subcortical Stroke

Combining Theta Burst Stimulation With Training After Subcortical Stroke
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DOI：
10.1161/strokeaha.110.583278
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发表时间：
2010-07-01
期刊：
STROKE
影响因子：
8.3
通讯作者：
Byblow, Winston D.
Byblow, Winston D.
中科院分区：
医学1区
文献类型：
--
作者：
Ackerley, Suzanne J.;Stinear, Cathy M.;Byblow, Winston D.

文献摘要

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背景和目的--重复的经颅磁刺激初级运动皮质(M1)可能会改善卒中后的预后。本研究旨在探讨M1 theta Burst刺激(TBS)和标准化运动训练对慢性卒中患者上肢功能的影响。方法：10例慢性皮质下卒中合并上肢功能障碍的患者，采用双盲交叉假对照研究。分别给予患侧M1的间歇性TBS、对侧M1的连续TBS和假TBS，同时结合使用偏瘫上肢的精确握力任务的标准化训练。结果：真实TBS后的训练改善了偏瘫患者手握力提升的动力学，而假TBS后的训练导致握力提升的恶化。单侧M1间歇性TBS后兴奋性增加，而对侧M1连续TBS后兴奋性降低。动作研究ARM测试成绩下降，当持续的TBS的对照M1，这与降低自身皮质运动兴奋性相关。尤其是对侧M1的持续TBS导致上肢功能的整体减退，提示对侧大脑半球可能在卒中后的恢复中起着关键作用。(笔划。2010；41：1568-1572。)
Background and Purpose-Repetitive transcranial magnetic stimulation of the primary motor cortex (M1) may improve outcomes after stroke. The aim of this study was to determine the effects of M1 theta burst stimulation (TBS) and standardized motor training on upper-limb function of patients with chronic stroke.Methods-Ten patients with chronic subcortical stroke and upper-limb impairment were recruited to this double-blind, crossover, sham-controlled study. Intermittent TBS of the ipsilesional M1, continuous TBS of the contralesional M1, and sham TBS were delivered in separate sessions in conjunction with standardized training of a precision grip task using the paretic upper limb.Results-Training after real TBS improved paretic-hand grip-lift kinetics, whereas training after sham TBS resulted in deterioration of grip-lift. Ipsilesional M1 excitability increased after intermittent TBS of the ipsilesional M1 but decreased after continuous TBS of the contralesional M1. Action Research Arm Test scores deteriorated when training followed continuous TBS of the contralesional M1, and this was correlated with reduced ipsilesional corticomotor excitability.Conclusions-Generally, TBS and training led to task-specific improvements in grip-lift. Specifically, continuous TBS of the contralesional M1 led to an overall decrement in upper-limb function, indicating that the contralesional hemisphere may play a pivotal role in recovery after stroke. (Stroke. 2010; 41: 1568-1572.)