高频重复经颅磁刺激联合功能性电刺激对脑卒中患者下肢痉挛及激活后抑制的影响

关键词：脑卒中  痉挛  高频重复经颅磁刺激  功能性电刺激  激活后抑制

Keywords:stroke  spasm  repetitive transcranial magnetic stimulation  functional electrical stimulation  post-activation depression

摘要：

      摘要 目的：探讨高频重复经颅磁刺激（repetitive transcranial magnetic stimulation， rTMS）联合功能性电刺激（functional electrical stimulation， FES）治疗对脑卒中患者下肢痉挛的作用及其对胫骨前肌和小腿三头肌激活后抑制（post activation depression， PAD）的影响。 方法：选择脑卒中伴随下肢痉挛的患者40例，采用随机数字序列法分为rTMS+FES联合治疗组（n=20）和对照组（n=20）。rTMS+FES联合治疗组患者进行rTMS和FES联合治疗，对照组进行单独FES治疗。治疗前后对患者采用临床痉挛指数（clinical spasticity index， CSI）评价痉挛严重程度；用H反射观察患者PAD水平，并记录患者静息运动阈值（resting motion threshold， RMT）和运动诱发电位（motion-evoked potential， MEP）引出率。 结果：治疗4周后，与治疗前相比，联合治疗组CSI评分[（4.70±2.23）分]、RMT[（66.00±8.83）%]显著降低，有显著性差异（P＜0.05）；联合治疗组胫骨前肌PAD、小腿三头肌PAD、MEP有效率分别为（0.34±0.18）%、（0.32±0.15）%、21.4 %，均显著优于对照组治疗后，有显著性差异（P＜0.05）；对照组各项指标未见显著性差异。Pearson相关回归分析结果显示，干预前后CSI评分与胫骨前肌PAD、小腿三头肌PAD均呈显著负相关，有显著性差异（P＜0.05）。 结论：高频rTMS联合FES治疗能有效改善脑卒中患者下肢痉挛，一定程度上提示高频rTMS联合FES治疗痉挛的机制与皮层兴奋性、皮质脊髓束通路完整性的提高有关。

Abstract:

      Abstract Objective： To investigate the effect of high-frequency repetitive transcranial magnetic stimulation （rTMS） combined with functional electrical stimulation （FES） on lower limb spasm and on post activation depression （PAD） of tibialis anterior muscle and soleus in stroke patients. Method： A total of 40 patients with stroke accompanied by lower limb spasm were selected and divided into rTMS+FES combined therapy group （n=20） and control group （n=20） by random number sequence method. Patients in the rTMS+FES combined group were treated with rTMS and FES， and the control group was treated with FES alone. The treatment was performed 5 days per week for 4 weeks. The clinical spasticity index （CSI） was used to assess the severity of spasticity before and after treatment. The patient's PAD was observed with the H-reflex， and the patient's resting motion threshold （RMT） and motion-evoked potential （MEP） elicitation were recorded. Result： After 4 weeks， the scores of CSI [(4.70±2.23) points] and RMT [(66.00±8.83)%] were significantly reduced （P<0.05）in the combined group. The tibial anterior muscle PAD and soleus muscle PAD and MEP elicitation rate were significantly increased [(0.34±0.18)%, (0.32±0.15)%, 21.4%, respectively, P<0.05]. There were no significant differences in the control group. Pearson analysis showed that CSI score was significantly negatively correlated with tibial anterior muscle PAD and soleus muscle PAD （P<0.05）. Conclusion： High-frequency rTMS combined with FES can significantly improve the lower limb spasm in stroke patients and improve the post activation depression of tibialis anterior muscle and soleus after activation. High-frequency rTMS combined with FES can improve cortical excitability and nerve conduction function in stroke patients.