高低频重复经颅磁刺激治疗卒中后上肢痉挛的对照研究

目的 探讨高、低频重复经颅磁刺激（repetitive transcranial magnetic stimulation，rTMS）大脑初级运动皮层（M1区）治疗卒中后上肢痉挛的临床疗效及差异。 

A Comparative Study of High and Low Frequency Repetitive Transcranial Magnetic Stimulation in Treatment of Upper Limb Spasticity after Stroke

Objective To investigate the clinical efficacy and differences of repetitive transcranial magnetic
stimulation (rTMS) for high-frequency and low-frequency stimulation in the treatment of stroke
upper limb spasticity.
Methods A total of 60 patients from department of neurology and physiotherapy with spasticity
were randomized to receive 10 Hz (n =20), 1 Hz (n =20) or sham (n =20) rTMS. The high-frequency
rTMS group and the low-frequency rTMS group were given rTMS for 40 days in the ipsilesional
and contralesional primary motor cortex. The stimulation frequency of the high-frequency
rTMS was 10 Hz and the stimulation intensity was 80% motor threshold (MT). The stimulation
frequency of the low-frequency rTMS was 1 Hz, 90% MT; the sham stimulation group received
sham stimulation. All of participants received conventional rehabilitation. All the treatments were
performed once a day, 5 times per week, and continued for 8 weeks. The modified Ashworth scale
(MAS), upper extremities motor function test of Fugl-Meyer movement assessment (U-FMA) and
modified Barthel index (MBI) were performed before and 8 weeks after treatment.
Results After treatment, there was a significant improvement of MAS U-FMA and MBI scores aftertreatment in three groups (P <0.01). The MAS,U-FMA and MBI scores of the low-frequency group
and high-frequency group were more obviously improved than that of the control group (P <0.05), but
there was no significant difference between the low frequency group and the high frequency group
(P >0.05).
Conclusion Low-frequency stimulation of the contralesional and high-frequency stimulation of the
ipsilesional M1 area can both effectively improve the clinical symptoms and motor function of the
spastic patients. There was no significant difference for their clinical efficacy.