Recovery of hemiplegia after stroke using transcranial magnetic stimulation

目的：目的：探讨经颅磁刺激（TMS）对慢性偏瘫患者手部运动功能的影响。方法：对9例偏瘫患者进行经颅磁刺激（TMS）治疗，干预组（n=5）采用经颅磁刺激（TMS）治疗，对照组（n=5）采用经颅磁刺激（TMS）治疗。（100个刺激;强度，刺激器输出的80%;刺激间隔，10秒）在患侧的指伸肌的最佳部位每周在手指伸展的最大努力期间施用，持续4周。对照组（n=4）给予假刺激，其他方法同干预组。结果：所有受试者在第1次治疗前和第4次治疗后均完成了试验，无不良反应。干预组有4名患者MAS和MFT评分均有改善，对照组无改善（χ 2检验，P<0.05）。每组中的一名参与者表现出Brunnstrom恢复期或SIAS的手部运动功能改善。结论：对脑卒中偏瘫患者进行与目标运动同步的重复性TMS训练，可改善患者的自主运动或缓解痉挛状态。

Purpose : We evaluated therapeutic effectiveness of transcranial magnetic stimulation (TMS) during maximal effort at a target movement in patients with chronic hemiplegia involving the hand.Subjects : 9 stroke patients with hemiplegia for at least 6 monthsDesign : Double-blinded trialMethods : For the intervention group (n=5), TMS (100 stimuli ; intensity, 80% of stimulator output ; interstimulus interval, 10 sec) was administered at the optimal site for the extensor digitorum muscle of the affected side weekly during maximal effort at finger extension for 4 weeks. For control group (n=4), sham stimulation was delivered otherwise in the same way as the intervention group. The outcome measures were Brunnstrom's recovery stage, Stroke Impairment Assessment Set (SIAS), Modified Ashworth Scale (MAS) for the wrist, Manual Function Test (MFT), tested just before the 1st and immediately after 4th session.Results : All the participants completed the trial, without any adverse. 4 participants of the intervention group showed improvement for either MAS or MFT, while participants of the control group showed neither of these scales (chi square test, P<0.05). One participant of each group showed improvement of the hand motor function for either Brunnstrom's recovery stage or SIAS. Either MAS or MFT improved in all the participants who showed enhancement of amplitudes for motor evoked potentials to TMS more than 30%.Conclusions : Repetitive TMS over the affected hemisphere of the hemiplegic stroke patients synchronized with maximal effort at a target movement improves the voluntary movement or reduces spasticity.