Recovery of motor function by noninvasive stimulation of the human brain.

1)建立癫痫高危患者经颅磁刺激期间脑电图监测系统。首先，我们测定了脑卒中患者经颅磁刺激（TMS）引起的脑电图（EEG）的变化和反应。为了减少刺激伪影，我们创建了一个电路，在刺激后阻断输入150毫秒。未观察到癫痫样后放电或尖波电位。在此初步研究之后，我们修改了伪影减少电路，以记录刺激后50 msec的脑电图。2)我们研究了随意运动中的易化，并证明易化发生在拮抗剂或其他异位肌的随意收缩过程中。研究还发现，由异位肌收缩引起的易化程度在个体肌肉之间，以及在优势和非优势前臂肌肉之间存在差异。3)研究了经颅磁刺激对健康人额叶功能、注意力、记忆和脑电图等认知功能的短期影响。因此，我们认为经颅磁刺激对认知和电生理功能没有不良影响。4) 1例脑卒中患者（48岁，男性，左侧皮膜出血，右侧偏瘫3年零4个月）提供知情同意参加本研究。每周经颅磁刺激（0.1 Hz， 100次刺激）通过运动皮层，持续3个月。受试者被指示在受到刺激时努力收缩目标肌肉（促进）。在刺激前，受试者可以屈曲手指（大规模屈曲），小指伸展不到5度（Brunnstrom阶段3）。刺激后，受试者除食指外，其余手指和拇指均可伸直，小指可单独活动。在前三个阶段，经颅磁刺激不能引起运动反应。第4期出现了经颅磁刺激诱发的运动反应，运动诱发电位幅度逐渐增大。未观察到癫痫样后放电或尖波电位。在未来的研究中，我们将在一项随机对照研究中调查经颅磁刺激的有效性，并提出经颅磁刺激治疗偏瘫的适应症。少

1) We established EEG monitoring system during TMS for patients with risk of epilepsy. First, we determined the changes and responses in the electroencephalogram (EEG) induced by transcranial magnetic stimulation (TMS) of the scalp of stroke patients. To reduce stimulus artifacts, we created a circuit that blocked the input for 150 msec after stimulation. No epileptiform afterdischarges or sharp wave potentials were observed. After this preliminary study, we revised the artifact-reducing circuit so as to record EEG 50 msec after stimulation.2) We investigated facilitation in voluntary movement, and demonstrated that facilitation occurs during voluntary contraction of antagonist or other heteronymous muscles. It also was found that the degree of facilitation induced by a heteronymous muscle contraction differed between individual muscles, and between dominant and nondominant forearm muscles.3) We investigated short-term effects of TMS over the frontal lobe on cognitive function such as … More frontal lobe function, attention, and memory, and EEG of healthy subjects. Then, we concluded that TMS has no adverse effects on cognitive and electrophysiologic function.4) One stroke patient (48 years of age, male, left putaminal hemorrhage, right hemiplegia for 3 years and 4 months) provided his informed consent to participate in this study. TMS (0.1 Hz, 100 stimuli) were delivered over the motor cortex every week for 3 months. The subject was instructed to make efforts of contracting the target muscle (facilitation) when stimulated. Before stimulation the subject could flex fingers (mass flexion), and extend the little finger less than 5 degrees (Brunnstrom stage 3). After stimulation the subject could extend all the fingers and thumb except the index finger, and move the little finger separately. TMS could not evoke motor responses during the first three sessions. Motor responses evoked by TMS appeared at the 4th session, and amplitudes of the motor evoked potentials increased gradually. No epileptiform afterdischarges or sharp wave potentials were observed. In the future study effectiveness of TMS will be investigated in a rondomized control study and an indication of TMS for treatment of hemiplegia will be suggested. Less