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汤昕未,胡瑞萍,朱玉连,范顺娟,吴军发,余克威,谢鸿宇,吴 毅.间歇性θ短阵脉冲刺激对脑卒中后运动功能障碍的影响[J].中国康复医学杂志,2018,(12):1410~1415
间歇性θ短阵脉冲刺激对脑卒中后运动功能障碍的影响    点此下载全文
汤昕未  胡瑞萍  朱玉连  范顺娟  吴军发  余克威  谢鸿宇  吴 毅
复旦大学附属华山医院康复医学科,200040
基金项目:上海市科学技术委员会项目(17411953900);上海市卫计委重要薄弱学科建设项目(2015ZB0401);上海市科学技术委员会项目(16411955400)
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摘要:
      摘要 目的:探索间歇性θ短阵脉冲刺激(iTBS)对脑卒中后运动功能障碍的影响。 方法:招募我院住院治疗的脑卒中后恢复期(1—6个月)严重上肢运动功能障碍患者,随机分为iTBS组和假刺激组。每位患者接受2周共10次对患侧M1的iTBS或假刺激干预。干预前、干预结束后第二天和1个月随访时分别对受试者进行上肢Fugl-Meyer评分、运动功能状态量表(MSS)、Barthel指数(BI)的评定和静息运动阈值(RMT)的测定。干预和评定均由经过专业培训后的专人完成。除干预实施者外,患者和所有涉及的研究人员均不知晓分组情况。 结果:共有16例患者(每组各8例)完成了这项前瞻性、单中心、单盲、随机、假刺激对照的探索性临床试验。所有受试者均能够耐受iTBS或假刺激。干预前后和随访时两组间上肢Fugl-Meyer评分、MSS、BI评分和健侧RMT的组间差异均无显著性意义(P>0.05)。两组干预后和1个月随访时的各项量表得分均明显高于干预前(P<0.01),但干预后和随访时的健侧RMT与基线相比无明显改变(P>0.05)。所有受试者干预前后和随访时均无法引出患侧第一骨间背侧肌(FDI)的运动诱发电位(MEP)。 结论:对于脑卒中后恢复期的严重上肢运动功能障碍的患者,在常规治疗的基础上额外增加iTBS刺激可能并不能在短时期内促进其运动功能的恢复。
关键词:脑卒中  经颅磁刺激  θ短阵脉冲刺激  运动功能障碍
The effect of intermittent theta burst stimulation on motor dysfunction after stroke    Download Fulltext
Dept. of Rehabilitation Medicine,Huashan Hospital,Fudan University,Shanghai,200040
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Abstract:
      Abstract Objective:To explore the effect of intermittent Theta burst stimulation (iTBS) on motor recovery after stroke. Method:Hospitalized patients with severe upper limb motor dysfunction after stroke (1 to 6 months) in our department were recruited to this study. Subjects were randomly divided into iTBS group and sham stimulation group. Every subject received 10 sessions of real or sham ipsilateral M1 iTBS. Upper limb Fugl-Meyer Assessment, Motor Status Score (MSS), Barthel Index (BI) and contralateral resting motor threshold (RMT) were assessed at the baseline, the second day and 1 month after the intervention. Intervention and assessments were completed by professional trained therapists. In addition to the person who performed the intervention, all patients and researchers involved in this study did not know the grouping. Result:A total of 16 patients (8 in each group) completed this prospective, single-center, single-blind, randomized, sham-controlled, exploratory clinical trial. All subjects were able to tolerate iTBS or sham stimulation. There was no significant difference between two groups in scores of Upper limb Fugl-Meyer Assessment, MSS, BI, as well as the contralateral RMT at the baseline, the second day and 1 month after the intervention (P>0.05). Two groups both performed much better in behavioral assessments after the intervention and 1 month follow up than at the baseline (P<0.01). However, the contralateral RMT in both groups appeared unchanged during the whole process of this clinical trial. All subjects were absent of the ipsilateral hand MEP (FDI) before, after the intervention and at the follow up. Conclusion:For patients with severe upper limb motor dysfunction in recovery period after stroke, applying additional iTBS on the conventional therapy may not be able to promote the recovery of motor function in a short period of time.
Keywords:stroke  transcranial magnetic stimulation  intermittent theta burst stimulation  motor dysfunction
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