Enhanced motor function and its neurophysiological correlates after navigated low-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex in stroke.
Enhanced motor function and its neurophysiological correlates after navigated low-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex in stroke.
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DOI：
10.3233/rnn-140460
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发表时间：
2016-08-11
影响因子：
2.8
通讯作者：
Pascual-Leone A
中科院分区：
文献类型：
--
作者：
Bashir S;Vernet M;Najib U;Perez J;Alonso-Alonso M;Knobel M;Yoo WK;Edwards D;Pascual-Leone A
单侧中风后，同源运动皮质区之间的大脑半球间相互作用的改变的净效应先前已被报道有助于残余轻偏瘫。使用这个框架，我们假设，导航1赫兹重复经颅磁刺激（rTMS）对侧半球将诱导一个更强的生理和行为反应的患者与残留的运动缺陷比健康受试者，因为在大脑半球间的兴奋性失衡可能是运动功能障碍的基础。在8例慢性卒中患者（67.50 ± 13.77岁）和8例可比的正常受试者（57.38 ± 9.61岁）中进行了导航rTMS。我们评估了运动功能（手指敲击，九孔钉测试，力量指数和反应时间）以及兴奋和抑制功能（静息运动阈值，运动诱发电位振幅，皮层内抑制和易化，和沉默期）的刺激和非刺激运动皮层导航rTMS之前和之后。rTMS诱导了同侧（非刺激）运动皮层兴奋性的增加，并导致手指敲击任务和捏力任务的表现改善。这些生理和行为影响在中风患者组中比对照组更突出（或更强）。导航低频rTMS涉及精确和一致的目标对侧半球中风患者增强了同侧半球的皮质兴奋性和偏瘫手的运动反应。
The net effect of altered interhemispheric interactions between homologous motor cortical areas after unilateral stroke has been previously reported to contribute to residual hemiparesis. Using this framework, we hypothesized that navigated 1 Hz repetitive transcranial magnetic stimulation (rTMS) over the contralesional hemisphere would induce a stronger physiological and behavioural response in patients with residual motor deficit than in healthy subjects, because an imbalance in interhemispheric excitability may underlie motor dysfunction. Navigated rTMS was conducted in 8 chronic stroke patients (67.50 ± 13.77 years) and in 8 comparable normal subjects (57.38 ± 9.61 years). We evaluated motor function (Finger tapping, Nine Hole Peg test, Strength Index and Reaction Time) as well as the excitatory and inhibitory function (resting motor threshold, motor evoked potential amplitude, intra-cortical inhibition and facilitation, and silent period) of the stimulated and non-stimulated motor cortex before and after navigated rTMS. rTMS induced an increase in excitability in the ipsilesional (non-stimulated) motor cortex and led to improved performance in the finger tapping task and pinch force task. These physiological and behavioral effects were more prominent (or robust) in the group of stroke patients than in the control group. Navigated low-frequency rTMS involving precise and consistent targeting of the contralesional hemisphere in stroke patients enhanced the cortical excitability of the ipsilesional hemisphere and the motor response of the hemiparetic hand.