Effects of low-frequency repetitive transcranial magnetic stimulation of the contralesional primary motor cortex on movement kinematics and neural activity in subcortical stroke
Effects of low-frequency repetitive transcranial magnetic stimulation of the contralesional primary motor cortex on movement kinematics and neural activity in subcortical stroke
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DOI：
10.1001/archneur.65.6.741
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发表时间：
2008-06-01
影响因子：
--
通讯作者：
Fink, Gereon R.
中科院分区：
文献类型：
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作者：
Nowak, Dennis A.;Grefkes, Christian;Fink, Gereon R.
背景资料：根据半球间竞争的概念，下调对侧初级运动皮层（M1）可能会改善中风后患手的灵活性。目的：确定1-Hz重复经颅磁刺激（rTMS）对皮质下中风后亚急性期运动系统运动学和神经激活的对侧M1的影响。设计：交叉研究。设置：A university hospital.Methods：15例右利手的患者，由于皮层下大脑中动脉卒中导致灵巧度受损，接受了10分钟的1 Hz rTMS，应用于头顶（对照刺激）和对侧病灶M1。对于行为测试，患者在2个基线条件下用双手进行手指和抓握运动，间隔1周，并在每次rTMS应用后进行。对于功能磁共振成像，患者进行手握运动与他们的影响或未受影响的手之前和之后，每个rTMS application.Results：应用rTMS的contralesional M1改善手指的运动学和把握运动在受影响的手。在神经水平，rTMS应用于对侧病灶M1减少对侧病灶的主要和非主要运动区的过度活跃。rTMS诱导的对侧损伤M1内血氧水平依赖性反应的减少与患手的行为改善程度之间没有显著相关性。对侧背侧运动前区、对侧顶叶盖和同侧近中额叶皮质的过度活动预示着对侧M1区rTMS治疗后患手运动学的改善。结论：对侧M1区rTMS治疗可使皮质下卒中后皮质运动网络内的神经激活正常化。根据个体皮层激活模式确定适合rTMS干预的患者可能有助于在卒中后运动康复中实施rTMS。
Background: Following the concept of interhemispheric competition, downregulation of the contralesional primary motor cortex (M1) may improve the dexterity of the affected hand after stroke.Objective: To determine the effects of 1-Hz repetitive transcranial magnetic stimulation (rTMS) of the contralesional M1 on movement kinematics and neural activation within the motor system in the subacute phase after subcortical stroke.Design: Crossover investigation.Setting: A university hospital.Methods: Fifteen right-handed patients with impaired dexterity due to subcortical middle cerebral artery stroke received 1-Hz rTMS for 10 minutes applied to the vertex (control stimulation) and contralesional M1. For behavioral testing, patients performed finger and grasp movements with both hands at 2 baseline conditions, separated by 1 week, and following each rTMS application. For functional magnetic resonance imaging, patients performed hand grip movements with their affected or unaffected hand before and after each rTMS application.Results: Application of rTMS to the contralesional M1 improved the kinematics of finger and grasp movements in the affected hand. At the neural level, rTMS applied to the contralesional M1 reduced overactivity in the contralesional primary and nonprimary motor areas. There was no significant correlation between the rTMS-induced reduction in blood oxygen level -dependent responses within the contralesional M1 and the degree of behavioral improvement of the affected hand. Overactivity of the contralesional dorsal premotor cortex, contralesional parietal operculum, and ipsilesional mesial frontal cortex at baseline predicted improvement of movement kinematics with the affected hand after rTMS of the contralesional M1.Conclusion: The functional magnetic resonance imaging data suggest that rTMS of the contralesional M1 may normalize neural activation within the cortical motor network after subcortical stroke. Identifying patients suitable for rTMS intervention based on individual patterns of cortical activation may help to implement rTMS in motor rehabilitation after stroke.