中华物理医学与康复杂志
中華物理醫學與康複雜誌
중화물리의학여강복잡지
CHINESE JOURNAL OF PHYSICAL MEDICINE AND REHABILITATION
2013年
7期
547-551
,共5页
随燕芳%宋振华%童良前%杨露%郭铁成
隨燕芳%宋振華%童良前%楊露%郭鐵成
수연방%송진화%동량전%양로%곽철성
经颅磁刺激%成对关联刺激%大脑皮质
經顱磁刺激%成對關聯刺激%大腦皮質
경로자자격%성대관련자격%대뇌피질
Transcranial magnetic stimulation%Paired associative stimulation%Cerebral cortex
目的 比较成对关联刺激(PAS)与重复经颅磁刺激(rTMS)对大脑皮质兴奋性的调节作用.方法 募集健康受试者10例.干预前检测所有受试者左侧大脑半球的运动诱发电位(MEP),记录其MEP波幅、MEP潜伏期和静息运动阈值(RMT);次日相同时间点,给予左侧大脑半球及其对侧腕部正中神经频率为0.05 Hz、强度为120％ RMT、刺激间隔(ISI)为10 ms(称为PAS10)、共90对脉冲的PAS干预,干预后1 min检测受试者左侧大脑半球MEP波幅、MEP潜伏期和RMT;间歇1周,以消除PAS10对受试者大脑皮质兴奋性的影响.在相同时间点给予同侧大脑半球频率为1 Hz、强度为120％ RMT、共1000个脉冲的rTMS干预,干预后1 min检测受试者左侧大脑半球的上述指标.分别比较干预前、PAS10干预后1 min、rTMS干预后1 rmin上述各项指标的变化.结果 干预前10例受试者MEP波幅、MEP潜伏期和RMT分别为(2.93±0.99)mY、(20.97±1.67)ms和(46.06±5.32)％;PAS10干预后1 min分别为(1.14 ±0.76)mV、(21.87±l.09)ms和(52.06±4.20)％;rTMS干预后1 min分别为(2.24±0.79)mY、(20.88±1.94)ms和(49.00±4.54)％.PAS10干预后1 rmin的MEP波幅、MEP潜伏时、RMT与PAS10干预前的差值分别为(1.83±0.14)mV、(0.90 ±0.26)ms和(6.00±1.13)％;rTMS干预后与干预前的MEP波幅、MEP潜伏期、RMT差值分别为(0.69±0.l0)mV、(0.09±0.05)ms和(3.94±0.93)％.rTMS干预后1 min与干预前比较,MEP波幅降低、RMT增大(P＜0.01),而MEP潜伏期无明显变化(P＞0.05);PAS10干预后1 min与干预前比较,MEP波幅降低、MEP潜伏期延长、RMT增大(P＜0.01).PAS10干预后1 min与rTMS干预后1 min比较,MEP波幅、MEP潜伏期、RMT差异均有统计学意义(P＜0.0l).而且,PAS10干预前、后MEP波幅、MEP潜伏期、RMT差值与rTMS干预前、后MEP波幅、MEP潜伏期、RMT差值间比较,差异均有统计学意义(P＜0.01).结论 PAS10以及低频rTMS对大脑皮质兴奋性均有抑制作用,而PAS10较低频rTMS对大脑皮质兴奋性抑制的即刻效应更明显.
目的 比較成對關聯刺激(PAS)與重複經顱磁刺激(rTMS)對大腦皮質興奮性的調節作用.方法 募集健康受試者10例.榦預前檢測所有受試者左側大腦半毬的運動誘髮電位(MEP),記錄其MEP波幅、MEP潛伏期和靜息運動閾值(RMT);次日相同時間點,給予左側大腦半毬及其對側腕部正中神經頻率為0.05 Hz、彊度為120％ RMT、刺激間隔(ISI)為10 ms(稱為PAS10)、共90對脈遲的PAS榦預,榦預後1 min檢測受試者左側大腦半毬MEP波幅、MEP潛伏期和RMT;間歇1週,以消除PAS10對受試者大腦皮質興奮性的影響.在相同時間點給予同側大腦半毬頻率為1 Hz、彊度為120％ RMT、共1000箇脈遲的rTMS榦預,榦預後1 min檢測受試者左側大腦半毬的上述指標.分彆比較榦預前、PAS10榦預後1 min、rTMS榦預後1 rmin上述各項指標的變化.結果 榦預前10例受試者MEP波幅、MEP潛伏期和RMT分彆為(2.93±0.99)mY、(20.97±1.67)ms和(46.06±5.32)％;PAS10榦預後1 min分彆為(1.14 ±0.76)mV、(21.87±l.09)ms和(52.06±4.20)％;rTMS榦預後1 min分彆為(2.24±0.79)mY、(20.88±1.94)ms和(49.00±4.54)％.PAS10榦預後1 rmin的MEP波幅、MEP潛伏時、RMT與PAS10榦預前的差值分彆為(1.83±0.14)mV、(0.90 ±0.26)ms和(6.00±1.13)％;rTMS榦預後與榦預前的MEP波幅、MEP潛伏期、RMT差值分彆為(0.69±0.l0)mV、(0.09±0.05)ms和(3.94±0.93)％.rTMS榦預後1 min與榦預前比較,MEP波幅降低、RMT增大(P＜0.01),而MEP潛伏期無明顯變化(P＞0.05);PAS10榦預後1 min與榦預前比較,MEP波幅降低、MEP潛伏期延長、RMT增大(P＜0.01).PAS10榦預後1 min與rTMS榦預後1 min比較,MEP波幅、MEP潛伏期、RMT差異均有統計學意義(P＜0.0l).而且,PAS10榦預前、後MEP波幅、MEP潛伏期、RMT差值與rTMS榦預前、後MEP波幅、MEP潛伏期、RMT差值間比較,差異均有統計學意義(P＜0.01).結論 PAS10以及低頻rTMS對大腦皮質興奮性均有抑製作用,而PAS10較低頻rTMS對大腦皮質興奮性抑製的即刻效應更明顯.
목적 비교성대관련자격(PAS)여중복경로자자격(rTMS)대대뇌피질흥강성적조절작용.방법 모집건강수시자10례.간예전검측소유수시자좌측대뇌반구적운동유발전위(MEP),기록기MEP파폭、MEP잠복기화정식운동역치(RMT);차일상동시간점,급여좌측대뇌반구급기대측완부정중신경빈솔위0.05 Hz、강도위120％ RMT、자격간격(ISI)위10 ms(칭위PAS10)、공90대맥충적PAS간예,간예후1 min검측수시자좌측대뇌반구MEP파폭、MEP잠복기화RMT;간헐1주,이소제PAS10대수시자대뇌피질흥강성적영향.재상동시간점급여동측대뇌반구빈솔위1 Hz、강도위120％ RMT、공1000개맥충적rTMS간예,간예후1 min검측수시자좌측대뇌반구적상술지표.분별비교간예전、PAS10간예후1 min、rTMS간예후1 rmin상술각항지표적변화.결과 간예전10례수시자MEP파폭、MEP잠복기화RMT분별위(2.93±0.99)mY、(20.97±1.67)ms화(46.06±5.32)％;PAS10간예후1 min분별위(1.14 ±0.76)mV、(21.87±l.09)ms화(52.06±4.20)％;rTMS간예후1 min분별위(2.24±0.79)mY、(20.88±1.94)ms화(49.00±4.54)％.PAS10간예후1 rmin적MEP파폭、MEP잠복시、RMT여PAS10간예전적차치분별위(1.83±0.14)mV、(0.90 ±0.26)ms화(6.00±1.13)％;rTMS간예후여간예전적MEP파폭、MEP잠복기、RMT차치분별위(0.69±0.l0)mV、(0.09±0.05)ms화(3.94±0.93)％.rTMS간예후1 min여간예전비교,MEP파폭강저、RMT증대(P＜0.01),이MEP잠복기무명현변화(P＞0.05);PAS10간예후1 min여간예전비교,MEP파폭강저、MEP잠복기연장、RMT증대(P＜0.01).PAS10간예후1 min여rTMS간예후1 min비교,MEP파폭、MEP잠복기、RMT차이균유통계학의의(P＜0.0l).이차,PAS10간예전、후MEP파폭、MEP잠복기、RMT차치여rTMS간예전、후MEP파폭、MEP잠복기、RMT차치간비교,차이균유통계학의의(P＜0.01).결론 PAS10이급저빈rTMS대대뇌피질흥강성균유억제작용,이PAS10교저빈rTMS대대뇌피질흥강성억제적즉각효응경명현.
Objective To compare the effects of paired associative stimulation (PAS) and repetitive transcranial magnetic stimulation (rTMS) on motor cortex excitability.Methods The baseline corticospinal excitability of the left hemispheres of 10 healthy subjects was measured in terms of resting motor threshold (RMT) and other indicators of motor evoked potentials (MEP).On the following day they received PAS composed of trascranial magnetic stimulation (TMS) to the motor cortex of the left hemisphere and electric stimulation (ES) of the median nerve contralateral to the motor cortex,with an interval of 10ms between the TMS and ES (termed PAS10).The PAS10 was delivered at a frequency of 0.05 Hz and an intensity of 120％ of the RMT,for a total of 90 pulses.The MEP amplitude,MEP latency and RMT were evaluated one minute after the stimulation.After the PAS intervention,an interval of one week was allowed to eliminate any effect of PAS on motor cortex excitability.Then rTMS was delivered to the subjects' left motor cortex at the same time of day at a frequency of 1 Hz and an intensity of 120％ of the RMT,for a total of 1000 pulses.MEP amplitude,MEP latency and RMT were evaluated one minute after the stimulation.The two interventions were compared in terms of MEP amplitude,MEP latency and RMT.Results The average MEP amplitude,MEP latency and RMT at baseline were (2.93 ± 0.99) mV,(20.97 ± 1.67) ms,and (46.06 ±5.32) ％,respectively.One minute after PAS10,the MEP amplitude,MEP latency and RMT were (1.14 ± 0.76) mV,(21.87 ± 1.09) ms and (52.06 ±4.20) ％,respectively.One minute after rTMS,the MEP amplitude and latency and the RMT were (2.24 ± 0.79) mV,(20.88 ± 1.94) ms,and (49.00 ± 4.54) ％,respectively.The differences in MEP amplitude,MEP latency and RMT pre-and post-intervention were (0.69 ± 0.10) mV,(0.09 ±0.05) ms and (3.94 ± 0.93) ％,respectively for rTMS.For PAS10 they were (1.83 ± 0.14) mV,(0.90 ± 0.26)ms and (6.00 ± 1.13)％,respectively.The differences in MEP amplitude decrease and MEP latency lengthening between the two stimulation protocols were significant,but the difference in RMT elevation was not.Conclusion Both PAS10 and low frequency rTMS suppressed motor cortex excitability,but the suppressive effect of PAS10 is more significant.
