重复经颅磁刺激联合吞咽动作观察对脑卒中吞咽障碍患者静息态fMRI的影响

关键词：脑卒中  吞咽困难  静息态功能磁共振  动作观察

Keywords:stroke  dysphagia  resting-state fMRI  action observation

摘要：

      摘要 目的：探究患侧BA6区高频重复经颅磁刺激（rTMS）结合吞咽动作观察对脑卒中吞咽障碍患者静息态皮层分析fMRI和吞咽功能的影响。 方法：治疗组和对照组均入选脑卒中吞咽困难患者14例。治疗组脑卒中患者进行高频rTMS刺激患侧BA6联合吞咽动作观察治疗，对照组进行rTMS假刺激患侧BA6区结合风景观察治疗。在治疗前和治疗后1个月后对所有入选受试者进行了静息态fMRI检查和吞咽功能评定。 结果：治疗后治疗组患者的吞咽功能较对照组评分改善（P＜0.001）。治疗组患者较对照组的左侧额下回的兴奋性增强；脑卒中吞咽障碍患者的右侧额下回岛盖部的局部一致性增强；治疗组患者较对照组患者的大脑后枕叶与中岛叶的脑区之间的功能连接降低。 结论：高频rTMS刺激脑卒中吞咽障碍患者BA6区联合吞咽动作观察治疗可以改善其吞咽功能，并提示可能可以提高脑卒中吞咽困难患者的大脑吞咽功能脑区的兴奋性。

Abstract:

      Abstract Objective： To investigate the effect of high-frequency rTMS over the affected BA6 area combined with swallowing action observation on resting state fMRI’s cortical analysis and swallowing function in stroke patients with dysphagia. Method： Fourteen patients with dysphagia in stroke were enrolled in both the treatment group and the control group. Stroke patients in the treatment group received high-frequency rTMS stimulation over the affected side of BA6 combined with swallowing action observation， and the control group received rTMS pseudo-stimulation over the same area combined with landscape observation. All selected subjects were assessed for resting state fMRI and swallowing function before and 1 month after treatment. Result： The swallowing function of patients in the post-treatment treatment group improved significantly compared to the control group（P＜0.001）. The excitability of the left inferior frontal gyrus in the treatment group was enhanced compared with that of the control group， and the local consistency of the right inferior frontal gyrus cap of the patients with stroke dysphagia was enhanced. Patients in the treatment group had a reduced functional connection between the posterior occipital and middle isolae lobes compared to the control group. Conclusion：High-frequency rTMS applied to the BA6 area combined with swallowing action observation therapy in patients with stroke dysphagia can improve their swallowing function， potentially by enhancing the excitability of cerebral swallowing function brain region in patients with stroke dysphagia.