Effectiveness of repetitive transcranial magnetic stimulation (rTMS) after acute stroke: A one-year longitudinal randomized trial
Effectiveness of repetitive transcranial magnetic stimulation (rTMS) after acute stroke: A one-year longitudinal randomized trial
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DOI：
10.1111/cns.12762
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发表时间：
2017-12-01
影响因子：
5.5
通讯作者：
Zhang, Wei-Hong
中科院分区：
文献类型：
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作者：
Guan, Yu-Zhou;Li, Jing;Zhang, Wei-Hong
目标：采用前瞻性、双盲、随机、假对照研究方法，评价重复经颅磁刺激（rTMS）对脑卒中后运动功能恢复的有效性。将患者随机分为rTMS治疗组和假手术组。我们对两组进行高频rTMS或假rTMS。在rTMS/假rTMS前后以及卒中发作后1个月、3个月、6个月和1年评估运动功能评分。采用美国国立卫生研究院卒中量表（NIHSS）、Barthel指数（BI）、Fugl-Meyer上肢/下肢功能评分（FMA-UL/LL）、改良Rank评分（mRS）和偏瘫肢体静息运动阈值（RMT）进行评分。经颅磁刺激治疗后第2天，真实的治疗组NIHSS、BI、FMA-UL评分较假手术组改善更明显。此外，在1个月时获得了相似的结果。结论：rTMS能促进急性脑卒中患者运动功能的恢复，除上肢功能改善可持续1年外，其效果可持续1个月。急性期单疗程rTMS可使上肢功能改善持续1年。
Aims: To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on motor recovery after stroke using a prospective, double-blind, randomized, sham-controlled study.Methods: Patients with unilateral subcortical infarction in the middle cerebral artery territory within 1 week after onset were enrolled. The patients were randomly divided into an rTMS treatment group and a sham group. We performed high-frequency rTMS or sham rTMS on the two groups. Motor functional scores were assessed pre- and post-rTMS/sham rTMS and at 1 month, 3 months, 6 months, and 1 year after stroke onset. The scores included the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Fugl-Meyer Assessment Upper Limb/Lower Limb (FMA-UL/LL), modified Rank Score (mRS), and the resting motor threshold (RMT) of the hemiplegic limb.Results: At baseline, no significant differences were found between the two groups for motor functional scores. On the second day after rTMS treatment, score improvements of the NIHSS, BI, FMA-UL in the real treatment group were more significant than those in the sham group. In addition, similar results were obtained at 1 month. However, at 3 months, 6 months, and 1 year after onset, no significant differences in improvement were observed between the two groups, except for the FMA-UL score improvement.Conclusion: rTMS facilitates motor recovery of acute stroke patients, and the effect can last to 1 month, except the function improvement on upper extremities could last for 1 year. A single course of rTMS in the acute stage may induce the improvement of upper extremities function lasted for 1 year.