Recovery of hemiplegia after stroke using transcranial magnetic stimulation

目的：我们评估经颅磁刺激（TMS）在最大努力的目标运动中对慢性偏瘫患者的治疗效果。设计：双盲试验方法：干预组（n=5），每周在患侧指伸肌的最佳部位进行TMS（100次刺激，强度为刺激器输出量的80%，刺激间隔10秒），持续4周。对照组（n=4）采用与干预组相同的方法进行假刺激。结果测量是Brunnstrom的恢复阶段，卒中损害评估集（SIAS），腕部改良Ashworth量表（MAS），手功能测试（MFT），在第一次之前和第4次之后进行测试。结果：所有受试者均完成试验，无不良反应。干预组有4名受试者在MAS和MFT量表上均有改善，对照组无改善（卡方检验，P<0.05）。在Brunnstrom恢复阶段或SIAS阶段，每组均有一名参与者的手部运动功能有所改善。运动诱发电位波幅在经颅磁刺激下增强30%以上的所有参与者的MAS或MFT均有改善。结论：在偏瘫脑卒中患者的患半球重复经颅磁刺激与目标运动的最大努力同步，可改善随意运动或减少痉挛。

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.