Repetitive Transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke
Repetitive Transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke
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DOI：
10.1161/01.str.0000189658.51972.34
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发表时间：
2005-12-01
期刊：
影响因子：
8.3
通讯作者：
Ikoma, K
中科院分区：
文献类型：
--
作者：
Takeuchi, N;Chuma, T;Ikoma, K
背景和目的——最近的一份报告表明，脑卒中患者的对侧初级运动皮层（M1）通过异常的经胼胝体抑制（TCI）抑制同侧M1。我们研究了1hz重复经颅磁刺激（rTMS）引起的对侧M1兴奋性降低是否通过释放TCI来改善中风患者患手的运动表现。方法：我们对脑卒中患者进行了真实与虚假rTMS的双盲研究。在患者进行了良好的运动训练以减少运动测量期间运动训练的可能性后，他们被随机分配接受对侧M1 （1 Hz， 25分钟）的阈下rTMS或假刺激。结果-与假刺激相比，rTMS降低了对侧M1的运动诱发电位振幅和TCI持续时间，rTMS立即诱导受影响手的挤压加速度的改善，尽管之前的运动训练已经达到了运动表现的平台期。rTMS后运动功能的改善与TCI持续时间的缩短显著相关。结论-我们已经证明，对侧M1虚拟病变对TCI的破坏导致中风患者受影响手的功能促进；这为中风患者提供了一种新的神经康复策略。
Background and Purpose - A recent report has demonstrated that the contralesional primary motor cortex (M1) inhibited the ipsilesional M1 via an abnormal transcallosal inhibition (TCI) in stroke patients. We studied whether a decreased excitability of the contralesional M1 induced by 1 Hz repetitive transcranial magnetic stimulation (rTMS) caused an improved motor performance of the affected hand in stroke patients by releasing the TCI.Methods - We conducted a double-blind study of real versus sham rTMS in stroke patients. After patients had well-performed motor training to minimize the possibility of motor training during the motor measurement, they were randomly assigned to receive a subthreshold rTMS at the contralesional M1 ( 1 Hz, 25 minutes) or sham stimulation.Results - When compared with sham stimulation, rTMS reduced the amplitude of motor-evoked potentials in contralesional M1 and the TCI duration, and rTMS immediately induced an improvement in pinch acceleration of the affected hand, although a plateau in motor performance had been reached by the previous motor training. This improvement in motor function after rTMS was significantly correlated with a reduced TCI duration.Conclusions - We have demonstrated that a disruption of the TCI by the contralesional M1 virtual lesion caused a paradoxical functional facilitation of the affected hand in stroke patients; this suggests a new neurorehabilitative strategy for stroke patients.