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目的:观察高频重复经颅磁刺激(r TMS)治疗脑卒中患者单侧空间忽略(USN)的临床疗效并调查r TMS疗效的神经影像学机制。方法:30例脑卒中后USN患者随机分为试验组和对照组各15例,两组患者均进行常规康复治疗;试验组给予额外的r TMS治疗,治疗强度为运动阈值的95%,频率10Hz,刺激点位于患侧右顶叶皮质区域(EEG 10-20标准的P4点),每次治疗10min,2次/d,连续治疗10天。观察治疗前及治疗10天后行为学表现和静息态f MRI改变情况。结果:和对照组相比,r TMS治疗后试验组USN症状明显改善(线段划销实验,P=0.038);图形删除测试,P=0.034;凯瑟琳-波哥量表,P<0.05);高频r TMS治疗可增强患侧脑区颞上回、额中回、顶上小叶、楔前叶及小脑前叶兴奋性,增强患侧半球的竞争抑制作用。结论:高频r TMS可明显改善脑卒中患者USN症状,并且可以使功能脑网络发生可塑性改变,平衡左右大脑半球兴奋性。
Objective: To observe the clinical efficacy of high frequency repetitive transcranial magnetic stimulation (r TMS) in the treatment of stroke patients with unilateral spatial neglect (USN) and to investigate the neuroimaging mechanism of r TMS. Methods: Thirty patients with USN were randomly divided into two groups: experimental group and control group, 15 cases each. Both groups received routine rehabilitation treatment. The experimental group received additional rTMS treatment with intensity of 95% of exercise threshold and frequency of 10 Hz , The stimulation point is located in the right parietal cortex (EEG 10-20 standard P4 point), each treatment 10min, 2 times / d, continuous treatment for 10 days. Observed before treatment and 10 days after treatment, behavioral performance and resting state f MRI changes. Results: USN symptoms were significantly improved in the experimental group after rTMS treatment compared with the control group (line segment test, P = 0.038); graphic deletion test, P = 0.034; Catherine-Bogot scale, P <0.05) Frequency r TMS treatment can enhance the superior ipsilateral temporal gyrus, frontal gyrus, apical lobule, anterior precordial lobes and anterior cerebellar excitability, increased ipsilateral hemisphere competitive inhibition. Conclusion: High-frequency r TMS can significantly improve the symptoms of stroke in patients with USN, and can make functional brain network changes in plasticity, balance left and right hemisphere excitability.