Repetitive Transcranial Magnetic Stimulation/Behavioral Intervention Clinical Trial: Long-Term Follow-Up of Outcomes in Congenital Hemiparesis.
Repetitive Transcranial Magnetic Stimulation/Behavioral Intervention Clinical Trial: Long-Term Follow-Up of Outcomes in Congenital Hemiparesis.
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DOI：
10.1089/cap.2015.0157
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发表时间：
2016-09
影响因子：
1.9
通讯作者：
T. Rich;J. Menk;L. Krach;T. Feyma;B. Gillick
中科院分区：
文献类型：
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作者：
T. Rich;J. Menk;L. Krach;T. Feyma;B. Gillick
目的探讨采用重复经颅磁刺激(RTMS)初级运动皮质联合强制性运动疗法(CIMT)对儿童及青少年脑卒中患者进行非药物干预的远期疗效。结果测量包括功能、满意度和医疗状况回顾。方法对参加rTMS/CIMT临床试验的19名受试者中的14名(74%)进行评估，其中真实rTMS+CIMT组8例，假rTMS+CIMT组6例。随访时受试者的中位年龄为13.4岁(范围11-20岁，50%为男性)。中位随访时间为47.5个月(21-57个月)。描述性统计使用频率和计数进行。使用辅助手评估(AHA)和加拿大职业表现测量(COPM)来测量运动能力。报告使用COPM和TMS耐受性调查的满意度。开放式访谈是关于研究经验和对当前功能状态的主观观点的反馈。结果总体而言，接受真实rTMS治疗的8名患者中有7名，接受假rTMS治疗的6名患者中有5名维持或改善了AHA评分。14名参与者中有6人报告了新的共发病情况(真实rTMS组中有4人，假rTMS组中有2人)。大多数参与者(86%)表示对研究感到满意。对医学状况的回顾揭示了共同发生的情况，包括：癫痫、强迫症、焦虑、抑郁、未指明的情绪障碍和未诊断的注意力不集中。结论rTMS/CIMT治疗儿童卒中的远期疗效是值得研究的。注意到表现的可变性和不明原因的症状。考虑到中风儿童和青少年的共发病情况，新出现的症状并不归因于最初的干预。由于样本量较小，rTMS对长期结果的影响不能从这些数据中完全确定。通过表现、参与者视角和医疗状况来表征长期结果，可以对rTMS/CIMT干预效果进行全面评估。
OBJECTIVE The purpose of this study was to examine long-term outcomes of nonpharmacological intervention in children and adolescents with stroke utilizing repetitive transcranial magnetic stimulation (rTMS) to the primary motor cortex combined with constraint- induced movement therapy (CIMT) to improve motor function in the paretic hand. Outcome measures included function, satisfaction, and medical status review. METHODS Fourteen of the original 19 participants (74%) from our rTMS/CIMT clinical trial (real rTMS+CIMT, n = 8; and sham rTMS+CIMT, n = 6) were evaluated. The median age of the subjects at follow up was 13.4 years (range 11-20 years old, 50% male). Median time to follow-up was 47.5 months (range 21-57 months). Descriptive statistics were conducted using frequencies and counts. Motor performance was measured using the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM). Satisfaction was reported with use of the COPM and TMS Tolerance Survey. Open-ended interview was conducted for feedback on study experience and subjective perspectives of current functional status. RESULTS Overall, seven of eight individuals who received real rTMS and five of six individuals who received sham rTMS maintained or improved AHA scores. Six of 14 participants reported new onset of co-occurring conditions (four individuals in the real rTMS group, two individuals in the sham rTMS group). The majority (86%) of participants reported study satisfaction. Review of medical status revealed co-occurring conditions including: Epilepsy, obsessive-compulsive disorder, anxiety, depression, unspecified mood disorder, and undiagnosed inattentiveness. CONCLUSIONS Long-term outcomes of rTMS/CIMT in pediatric stroke were investigated. Variability in performance and unattributed symptoms were noted. Considering the prevalence of co-occurring conditions in children and adolescents with stroke, new-onset symptoms were not attributed to original intervention. With the small sample size, the impact of rTMS on long-term outcomes cannot be fully determined from these data. Characterizing long-term outcomes through performance, participant perspectives, and medical status allows comprehensive assessment of rTMS/CIMT intervention efficacy.