经颅磁刺激在脑卒中后痉挛中的临床应用进展

被引：25

作者：

梅盛瑞 ^{[1
]}

许晴 ^{[1
]}

袁鹏 ^{[1
]}

徐磊 ^{[2
]}

刘小曼 ^{[3
]}

机构：

[1] 南京医科大学附属无锡人民医院康复医学科

[2] 蚌埠医学院第一附属医院康复医学科

[3] 苏州高新区人民医院康复医学科

来源：

中华全科医学 | 2020年 / 18卷 / 12期

关键词：

经颅磁刺激; 脑卒中; 痉挛;

D O I：

10.16766/j.cnki.issn.1674-4152.001693

中图分类号：

R743.3 [急性脑血管疾病（中风）];

学科分类号：

100204 [神经病学];

摘要：

脑卒中后痉挛(post-stroke spasticity,PSS)是卒中后常见的运动障碍表现形式之一,发生率高。主要表现为上肢屈肌群及下肢伸肌群肌张力增强。痉挛很大程度上影响日常生活能力,降低生活质量,故PSS的治疗尤为重要。PSS的治疗包括药物治疗、手法牵伸、神经阻滞疗法等,治疗方法均有其各自的优缺点,目前没有统一最优方案,以综合治疗为主。经颅磁刺激(TMS)治疗是一种非侵入性磁刺激技术,通过电磁感应原理,改变大脑皮层兴奋性,目前已广泛应用于神经系统疾病当中。经颅磁刺激治疗痉挛按治疗部位不同可分为应用于中枢及应用于外周。应用于中枢时,根据治疗模式的不同又分为低频重复经颅磁刺激(rTMS)、高频rTMS以及模式化TMS。研究大多采用1 Hz-rTMS作用于受累侧大脑半球,少量研究应用间歇性爆发性θ波刺激(iTBS)作用于受累侧大脑半球、10 Hz-rTMS作用于受累侧大脑半球。高频rTMS或iTBS作用于受累侧大脑半球,提高皮层兴奋性,加强上位中枢对脊髓运动神经元的控制,降低运动神经元的兴奋性和肌梭敏感性,改善痉挛症状。而低频rTMS作用于非受累侧大脑半球,降低非受累侧半球的兴奋性,减少非受累侧皮层对受累侧皮层的抑制作用,恢复双侧半球间的平衡,间接加强受累侧半球对脊髓运动神经元的控制。应用于外周目前的研究基本采用高频rTMS治疗。本综述旨在阐述经颅磁刺激在治疗脑卒中后痉挛方面的临床应用进展。

引用

页码：2078 / 2081+2098 +2098

页数：5

共 19 条

[1]

The use ultrasound guided for refilling intrathecal baclofene pump in complicated clinical cases: A practical approach.[J].P. Caruso;G. Mazzon;V.M. Sarra;L. Tacconi;P. Manganotti.Journal of Clinical Neuroscience.2018,

[2]

A retrospective study to assess resource utilization and costs in patients with post-stroke spasticity in the United Kingdom [J].

Raluy-Callado, Mireia ;

Cox, Andrew ;

MacLachlan, Sharon ;

Bakheit, Abdel M. ;

Moore, A. Peter ;

Dinet, Jerome ;

Gabriel, Sylvie .

CURRENT MEDICAL RESEARCH AND OPINION, 2018, 34 (07) :1317-1324

[3]

The Onset and Frequency of Spasticity After First Ever Stroke [J].

Katoozian, Leila ;

Tahan, Nahid ;

Zoghi, Maryam ;

Bakhshayesh, Babak .

JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, 2018, 110 (06) :547-552

[4]

Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on lower limb spasticity classified by spastic muscle echo intensity in post-stroke patients [J].

Hara, Takatoshi ;

Abo, Masahiro ;

Hara, Hiroyoshi ;

Kobayashi, Kazushige ;

Shimamoto, Yusuke ;

Shibata, Yamato ;

Sasaki, Nobuyuki ;

Yamada, Naoki ;

Niimi, Masachika .

INTERNATIONAL JOURNAL OF NEUROSCIENCE, 2018, 128 (05) :412-420

[5]

Modulation of iTBS after-effects via concurrent directional TDCS: A proof of principle study [J].

Tremblay, Sara ;

Hannah, Ricci ;

Rawji, Vishal ;

Rothwell, John C. .

BRAIN STIMULATION, 2017, 10 (04) :744-747

[6]

Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on upper and lower limb spasticity in post-stroke patients [J].

Hara, Takatoshi ;

Abo, Masahiro ;

Hara, Hiroyoshi ;

Kobayashi, Kazushige ;

Shimamoto, Yusuke ;

Samizo, Yuta ;

Sasaki, Nobuyuki ;

Yamada, Naoki ;

Niimi, Masachika .

INTERNATIONAL JOURNAL OF NEUROSCIENCE, 2017, 127 (06) :469-478

[7]

Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients [J].

Rastgoo, Maryam ;

Naghdi, Sofia ;

Ansari, Noureddin Nakhostin ;

Olyaei, Gholamreza ;

Jalaei, Shohreh ;

Forogh, Bijan ;

Najari, Hamidreza .

DISABILITY AND REHABILITATION, 2016, 38 (19) :1918-1926

[8]

Ultrasound Guidance for Technically Challenging Intrathecal Baclofen Pump Refill: Three Cases and Procedure Description.[J].Mithra B. Maneyapanda;George C. Chang Chien;Ryan Mattie;Prin Amorapanth;Christopher Reger;Zachary L. McCormick.American Journal of Physical Medicine & Rehabilit.2016,

[9]

A pilot study on the effects of low frequency repetitive transcranial magnetic stimulation on lower extremity spasticity and motor neuron excitability in patients after stroke [J].