고빈도 반복 경두부 자기자극이 뇌졸중의 운동 기능에 미치는 영향 = The Effect of High Frequency Repetitive Transcranial Magnetic Stimulation on the Motor Function in Post-Stroke Patients

다국어 초록 (Multilingual Abstract)

Objective: To evaluate the effects of high frequency repetitive transcranial magnetic stimulation (rTMS) of the affected hemisphere on the motor recovery and spasticity in chronic post-stroke hemiplegic patients.
Method: Thirteen chronic stroke hemiplegic patients were randomized to receive real and sham rTMS. rTMS was carried out 10 times at a frequency of 10 Hz with 10 s stimulation followed by 50 s rest, totalling 1,000 stimulations to the affected primary motor cortex using an intensity of 100% of resting motor threshold of unaffected hemisphere. Median nerve H-reflex, modified Ashworth scale (MAS) at elbow and wrist, and manual function test (MFT) were measured at baseline and after 2 weeks of treatment.
Results: High frequency rTMS resulted in increased H- reflex latency and decreased H-reflex amplitude and H/M ratio. Also MAS decreased and MFT score increased after 2 weeks of treatment.
Conclusion: High frequency rTMS in the affected motor cortex might facilitate motor recovery and reduce spasticity in chronic stroke patients. (J Korean Acad Rehab Med 2010; 34: 168-173)

참고문헌 (Reference)

1 김성우, "뇌성마비 아동에서 일회성 다부위 신경융해술이 상지 기능에 미치는 효과" 대한재활의학회 30 (30): 462-467, 2006

2 Pomeroy VM, "Transcranial magnetic stimulation and muscle contraction to enhance stroke recovery: a randomized proof- of-principle and feasibility investigation" 21 : 509-517, 2007

3 Michimata A, "The manual function test: Norms for 20-to 90-year-olds and effects of age, gender and hand dominance on dexterity" 214 : 257-267, 2008

4 Angel RW, "The H reflex in normal, spastic and rigid subjects" 9 : 591-596, 1963

5 Perez MA, "Short-term adaptations in spinal cord circuits evoked by repetitive transcranial magnetic stimulation, possible underlying mechanisms" 162 : 202-212, 2005

6 Kim YH, "Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke" 37 : 1471-1476, 2006

7 Málly J, "Recovery of motor disability and spasticity in post-stroke after repetitive transcranial magnetic stimulation (rTMS)" 76 : 388-395, 2008

8 Braddom RL, "Physical medicine and rehabilitation" Saunders 1191-1192, 2007

9 Sohn MK, "Modulation of spinal excitability by repetitive transcranial magnetic stimulation of motor cortex" 9 : 109-115, 2007

10 Duncan PW, "Measurement of motor recovery after stroke. Outcome assessment and sample size requirements" 23 : 1084-1089, 1992

11 Peinemann A, "Long lasting increase in corticospinal excitability after 1800 pulses of subthreshold 5 Hz repetitive TMS to the primary motor cortex" 115 : 1519-1526, 2004

12 Berardelli A, "Facilitation of muscle evoked responses after repetitive cortical stimulation in man" 122 : 79-84, 1998

13 Sugawara K, "Facilitation of motor evoked potentials and H reflexes of flexor carpi radialis muscle induced by voluntary teeth clenching" 21 : 203-212, 2002

14 Hankey GJ, "Electrostimulation for promoting recovery of movement or functional ability after stroke. Systemic review and meta-analysis" 37 : 2441-2442, 2006

15 Inghilleri M, "Effects of transcranial magnetic stimulation on the H reflex and F wave in the hand muscles" 114 : 1096-1101, 2003

16 Dafotakis M, "Effects of rTMS on grip force control following subcortical stroke" 211 : 407-412, 2008

17 Di Lazzaro V, "Direct demonstration that repetitive transcranial magnetic stimulation can enhance corticospinal excitability in stroke" 37 : 2850-2853, 2006

18 Chen R, "Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation" 48 : 1398-1403, 1997

19 Jaberzadeh S, "Between-days reliability of H-reflexes in human flexor carpi radialis" 85 : 1168-1173, 2004

20 Talelli P, "Arm function after stroke: neurophysiological correlates and recovery mechanisms assessed by transcranial magnetic stimulation" 117 : 1641-1659, 2006

21 Touge T, "Are the after-effects of low-frequency rTMS on motor cortex excitability due to changes in the efficacy of cortical synapses?" 112 : 2138-2145, 2001

22 Fregni F, "A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients" 37 : 2115-2122, 2006

23 Pandyan AD, "A review of the properties and limitations of the Ashworth and modified Ashworth scales as measures of spasticity" 13 : 373-383, 1999