摘要
【目的】通过经颅磁刺激(transcranial magnetic stimulation,TMS)运动诱发电位(motor evoked potential,MEP)和静息期(silentperiod,SP)探讨急性脑梗死患者急性期及恢复期皮层兴奋性变化及其对卒中预后的评估价值。【方法】选择37例单侧大脑半球脑梗死患者发病7d时及90d时行MEP、SP检查,同时进行临床评分:神经功能缺损评分(美国国立卫生院神经功能缺损评分,NIHSS)、日常生活能力评分(Barthel指数,BI)以及肢体痉挛状态评分(修改的Ashworth痉挛评定法,MAS);观察患侧皮质阈值和SP,分析患者皮层兴奋性的变化情况及其与临床评分的相关性。【结果】与健侧相比,7d时患侧的阈值增高,SP延长,差异具有显著性(P<0.01),患侧90d时二者较发病初阈值降低,SP缩短(P<0.01),部分患者MEP、SP未引出;SP与患者的NIHSS、MAS呈正相关,SP与患者的BI呈负相关。【结论】卒中后患者皮层兴奋状态会发生显著变化,患侧半球的兴奋性降低,而健侧半球的皮层兴奋性相对增高,而且SP能作为评价急性脑梗死患者神经功能损伤状况的早期预测因子,对患者肢体痉挛发生有预测价值,指导临床治疗。
[Objective] To investigate the changes of cortical excitability and the prognostic evaluation of motor function recovery by motor evoked potential and silent period of transcranial magnetic stimulation（TMS） in patients with acute ischemic stroke. [Methods] A total of 37 patients with hemiparesis were studied in the first week and 90 days after ischemic stroke and scored by NIHSS, BI and MAS. TMS （Medtronic R30） was performed at the same time, recording the MEP and SP in the thenar eminence muscles. The relevance rating of MEP, SP and clinical scores were analyzed. [ Results] MEP and SP were significantly different in the affected hemisphere in patients compared with the unaffected hemisphere in 7 days after stroke. It was the same in the affected hemisphere in 7 days compared with those in 90 days. It had showed better functional recovery in patients who were detected MEP and SP than those not. The SP was positively correlated with the patient＇s NIHSS and MAS,but negatively with BI. [Conclusions] There are significant changes on excitability of cortex in patients with acute stroke, the excitability of affected hemisphere is decreased while the contralateral hemisphere increased. SP in patients with hemiparesis after acute isehemic stroke is a useful early prognostic indicators of motor function recovery. SP may serve as a sensitive indicator of nerve damage in early assessment of patients. We can predict the occurrence of spasm by SP, which will have the significance in guiding the treatment.
出处
《武警医学院学报》
CAS
2010年第1期17-19,25,共4页
Acta Academiae Medicinae CPAPF
基金
天津市科技发展计划项目(06YFSZSF01700)
关键词
脑梗死
皮层兴奋性
经颅磁刺激
运动诱发电位
静息期
Ischemie stroke
Cortical excitability
Transcranial magnetic stimulation
Motor evoked potential
Silent period
