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中华脑科疾病与康复杂志(电子版) ›› 2020, Vol. 10 ›› Issue (06) : 352 -356. doi: 10.3877/cma.j.issn.2095-123X.2020.06.008

所属专题： 文献；

临床研究

作用于小脑的低频rTMS对后循环缺血卒中患者的下肢运动功能及皮层兴奋性的影响
段强1, 孙良文1, 韦春霞1, 卢敏1, 余凤立1, 黄杰1, 黄肖群1,†()   
  1. 1. 443000　湖北宜昌，宜昌市第一人民医院康复医学科
  • 收稿日期:2020-10-16 出版日期:2020-12-15
  • 通信作者: 黄肖群
  • 基金资助:
    湖北省自然科学基金面上项目(2020CFB756); 湖北省宜昌市科技局科技计划项目(A9-301-21); 三峡大学科学基金青年科学基金项目(KJ2018A006)

Effect of cerebellar low frequency rTMS on lower lamb motor function and cortical excitability in patients with posterior circulation stroke

Qiang Duan1, Liangwen Sun1, Chunxia Wei1, Min Lu1, Fengli Yu1, Jie Huang1, Xiaoqun Huang1,†()   

  1. 1. Department of Rehabilitation Medicine, The First People’s Hospital of Yichang, Yichang 443000, China
  • Received:2020-10-16 Published:2020-12-15
  • Corresponding author: Xiaoqun Huang
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段强, 孙良文, 韦春霞, 卢敏, 余凤立, 黄杰, 黄肖群. 作用于小脑的低频rTMS对后循环缺血卒中患者的下肢运动功能及皮层兴奋性的影响[J]. 中华脑科疾病与康复杂志(电子版), 2020, 10(06): 352-356.

Qiang Duan, Liangwen Sun, Chunxia Wei, Min Lu, Fengli Yu, Jie Huang, Xiaoqun Huang. Effect of cerebellar low frequency rTMS on lower lamb motor function and cortical excitability in patients with posterior circulation stroke[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(06): 352-356.

目的

探究作用于小脑的重复经颅磁刺激（rTMS）对后循环缺血性卒中（PCS）患者下肢运动功能的临床疗效和大脑皮层兴奋性变化，并初步探讨其作用机制。

方法

收集宜昌市第一人民医院康复医学科自2019年1月至12月收治的27例PCS患者，按照随机数字表法分为治疗组（13例）与对照组（14例）。2组患者均接受常规物理治疗，治疗组再此基础上给予rTMS治疗，刺激部位为健侧小脑（体表定位为枕骨粗隆旁开3 cm、下移1 cm处），重复频率为1 Hz，80%静息运动阈值（RMT），刺激数为1600个，每天1次，连续4周；对照组的刺激参数与治疗组一样，但仅有声音提示。分别在治疗前、治疗4周后采用Fugl-Meyer运动量表（FMA）、Fugl-Meyer平衡量表（FMBS）和威斯康星步态量表（WGS）对患者进行功能评估，同时检测患者的RMT、皮层运动诱发电位（MEP）波幅的变化，并将运动功能改善与皮层兴奋性的变化进行相关性分析。

结果

治疗4周后，2组患者的FMA、FMBS及WGS评分均有不同程度的提高，RMT降低、MEP波幅增高（P<0.05）；与对照组相比，治疗组RMT和MEP波幅的改变更明显（P<0.05）。进一步研究发现，FMBS的改善程度与RMT的变化呈负相关（P<0.05）。

结论

作用于小脑的低频rTMS能有效改善后循环卒中患者的下肢运动功能，其机制可能与其增加了大脑的皮层兴奋性有关。

关键词: 小脑, 后循环缺血性卒中, 重复经颅磁刺激, 静息运动阈值, 运动诱发电位
Objective

To observe the effects of repetitive transcranial magnetic stimulation (rTMS) on lower extremity motor function and cerebral cortex excitability in patients with posterior circulation stroke(PCS), and to explore its mechanism.

Methods

Twenty-seven stroke patients with PCS, admitted to Rehabilitation Medicine Department of The First People’s Hospital of Yichang from January to December 2019, were randomly divided into treatment group (n=13) and control group (n=14). Patients in both groups received routine physiotherapy, and the patients in the treatment group were treated with rTMS. The stimulation site was the contralateral cerebellum (the body surface was located at the site of 3 cm adjacent to the trochanter of the occipital bone and moved downward to 1 cm), the repetition rate was 80% resting motor threshold (RMT), and the number of stimuli was 1600, once a day for 4 consecutive weeks. The stimulation parameters of the control group were the same as those of the treatment group, but only sound cues. Fugl-Meyer motor scale (FMA), Fugl-Meyer balance scale (FMBS) and Wisconsin gait scale (WGS) walking function were used to evaluate the function of the patients before and 4 weeks after treatment. At the same time, the changes of RMT and cortical motor evoked potential (MEP) amplitude were measured, and the correlation between the improvement of motor function and cortical excitability was analyzed.

Results

After 4 weeks of treatment, the scores of FMA, FMBS and WGS increased, RMT decreased and MEP amplitude increased in the two groups (P<0.05), and the changes of RMT and MEP amplitudes in the treatment group were more obvious than those in the control group (P<0.05). The negative correlation between the improvement of FMBS and the change of RMT (P<0.05).

Conclusion

Low frequency rTMS acting on the cerebellum can effectively improve the balance function of patients with PCS, and its mechanism may be that it increases the cortical excitability of the brain.

Key words: Cerebellar, Posterior circulation stroke, Repetitive transcranial magnetic stimulation, Resting motor threshold, Motor evoked potential
表1 2组患者一般资料的比较
项目 治疗组（n=13） 对照组（n=14） χ2/t值 P值
年龄（年，Mean±SD） 46.77±9.56 47.86±6.50 0.349 0.728
性别（男/女） 7/6 6/8 0.326 0.713
病程（周，Mean±SD） 5.77±1.24 4.93±1.00 1.944 0.081
PCS梗死部位（左/右） 8/5 7/7 0.364 0.704
MMSE评分（分，Mean±SD） 22.77±1.79 22.57±2.17 0.260 0.786
NISHH评分（分，Mean±SD） 6.23±2.20 6.14±2.18 0.107 0.923
表2 2组患者治疗前后功能评估量表对比
项目 治疗组（n=13） 对照组（n=14）
治疗前 治疗后 t值 P值 治疗前 治疗后 t值 P值
FMA（下肢） 19.31±1.31 26.18±1.24 13.732 0.001 18.75±1.08 24.73±1.42a 12.542 0.001
FMBS（平衡） 5.31±1.08 8.38±1.14 7.049 0.001 5.19±1.21 6.73±1.03a 3.626 0.003
WGS（步行） 15.31±1.64 8.18±1.85 10.399 0.001 14.61±1.28 11.73±1.43a 5.615 0.001
RMT（%） 60.51±5.93 51.23±4.28 4.575 0.001 59.84±3.72 57.56±5.18a 2.373 0.041
MEP波幅（μV） 2.84±0.59 3.31±0.56 2.083 0.034 2.68±0.61 2.86±0.54a 2.827 0.026
表3 FMA、FMBS及WGS评分与RMT、MEP波幅的相关性分析
评分 组别 例数 RMT MEP波幅
r值 P值 r值 P值
FMA 治疗组 13 -0.239 0.321 0.732 0.851
对照组 14 -0.431 0.527 0.009 0.175
FMBS 治疗组 13 -0.534 0.016 0.732 0.062
对照组 14 -0.493 0.577 0.329 0.178
WGS 治疗组 13 -0.528 0.316 0.732 0.632
对照组 14 -0.476 0.732 0.195 0.175
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