Comparative study on the effect of bilateral and unilateral repetitive transcranial magnetic stimulation on motor function of children with spastic hemiplegia cerebral palsy

doi:10.11852/zgetbjzz2018-26-05-19

Abstract

Abstract: Objective To observe the effect of high-frequency combined with low-frequency repetitive transcranial magnetic stimulation (HF-rTMS and LF-rTMS) on the motor function of children with spastic cerebral palsy. Methods A total of 30 patients with spastic hemiplegic cerebral palsy were divided into two groups using a random number table method. Both groups received routine rehabilitation training and HF-rTMS on the affected hemisphere. In addition, the control group received pseudo-stimulation on the unaffected hemisphere and the observation group received LF-rTMS. Gross Motor Function Measure(GMFM)-88 and fine motor function measure (FMFM) were used to evaluate motor function before and after the session. Results Scores of GMFM-88 and FMFM in two groups were higher after the intervention with significant difference(P<0.05), especially in the observation group. Conclusion Conventional rehabilitation therapy combined with bilateral rTMS model can better improve the upper limb motor function and gross motor function of children with spastic hemiplegia cerebral palsy than the unilateral stimulation model.

Key words: repetitive transcranial magnetic stimulation, spastic hemiplegic cerebral palsy, fine motor, gross motor

摘要： 目的观察高频结合低频重复经颅磁刺激(HF-rTMS和LF-rTMS)对痉挛型偏瘫脑瘫患儿运动功能的影响。方法将30例痉挛型偏瘫脑瘫患儿采用随机数字表法分为对照组和观察组,两组患儿均接受常规康复训练和受损伤半球的HF-rTMS,在此基础上对照组于未受损半球接受伪刺激,观察组接受LF-rTMS。试验前后使用粗大运动功能测试(GMFM-88)和精细运动能力测试量表(FMFM)进行评估。结果治疗8周后,两组患儿GMFM-88评分和FMFM评分均较治疗前有改善,差异具有统计学意义(P<0.05),且观察组患儿的改善效果优于对照组,差异具有统计学意义(P<0.05)。结论在常规康复治疗的基础上结合双侧rTMS(BL-rTMS)模式比结合单侧刺激模式更能改善痉挛型偏瘫脑瘫患儿的上肢运动功能和粗大运动功能。

关键词: 重复经颅磁刺激, 痉挛型偏瘫脑瘫, 精细运动, 粗大运动

CLC Number:

R179

ZHANG Yang-ping, ZHANG Li-hua, LI Xue-mei, TANG Jing-hua. Comparative study on the effect of bilateral and unilateral repetitive transcranial magnetic stimulation on motor function of children with spastic hemiplegia cerebral palsy[J]. journal1, 2018, 26(5): 533-536.

张杨萍, 张丽华, 李雪梅, 汤敬华. 双侧与单侧重复经颅磁刺激对痉挛型偏瘫脑瘫患儿运动功能影响的对比研究[J]. 中国儿童保健杂志, 2018, 26(5): 533-536.

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URL: https://manu41.magtech.com.cn/Jwk_zgetbjzz/EN/10.11852/zgetbjzz2018-26-05-19

https://manu41.magtech.com.cn/Jwk_zgetbjzz/EN/Y2018/V26/I5/533

References

[1] Staudt M. Brain plasticity following early life brain injury: insights from neuroimaging[J]. Semin Perinatol, 2010, 34(1):87-92.
[2] Smith SE, Gray V, Cucchiara AJ, et al. Hemiparesis and epilepsy are associated with worse reported health status following unilateral stroke in children[J]. Pediatr Neurol, 2015, 52(4):428-434.
[3] Raun SH. Cerebral palsy in eastern Denmark: declining birth prevalence but increasing numbers of unilateral cerebral palsy in birth year period 1986-1998[J]. Eur J Paediatr Neuro, 2010, 14(3):214.
[4] Hosomi K, Morris S, Sakamoto T, et al. Daily repetitive transcranial magnetic stimulation for poststroke upper limb paresis in the subacute period[J]. J Stroke Cerebrovasc Dis, 2016, 25(7):1655-1664.
[5] Tretriluxana J, Kantak S, Tretriluxana S, et al. Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance after chronic stroke[J]. Disabil Rehabil Assist Technol, 2013, 8(2):121-124.
[6] Gupta M, Lal RB, Bhatia D, et al. Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients[J]. J Med Eng Technol, 2016, 40(4):210-216.
[7] Flamand VH, Schneider C. Noninvasive and painless magnetic stimulation of nerves improved brain motor function and mobility in a cerebral palsy case[J]. Arch Phys Med Rehabil, 2014, 95(10):1984-1990.
[8] Buma F, Kwakkel G, Ramsey N. Understanding upper limb recovery after stroke[J]. Restor Neurol Neurosci, 2013, 31(6):707-722.
[9] Corti M, Patten C, Triggs W. Repetitive transcranial magnetic stimulation of motor cortex after stroke: a focused review[J]. Am J Phys Med Rehabil, 2012, 91(3):254-270.
[10] Koganemaru S, Mima T, Thabit MN, et al. Recovery of upper-limb function due to enhanced use-dependent plasticity in chronic stroke patients[J]. Brain, 2010, 133(11):3373-3384.
[11] 李海峰, 尹宏伟, 邹艳,等. 重复经颅磁刺激对痉挛偏瘫型脑瘫患儿肢体运动功能的影响[J]. 中华物理医学与康复杂志, 2016, 38(6):433-435.
[12] 张丽华, 郄淑燕, 张黎明,等. 重复经颅磁刺激对痉挛型脑瘫患儿痉挛及运动功能的影响[J]. 中国康复, 2015,30(3):171-173.
[13] Kirton A, Chen R, Friefeld S, et al. Contralesional repetitive transcranial magnetic stimulation for chronic hemiparesis in subcortical paediatric stroke: a randomised trial[J]. Lancet Neurol, 2008, 7(6):507-513.
[14] Kondo T, Kakuda W, Yamada N, et al. Effects of repetitive transcranial magnetic stimulation and intensive occupational therapy on motor neuron excitability in poststroke hemiparetic patients: a neurophysiological investigation using F-wave parameters[J]. Int J Neurosci, 2015, 125(1):25-31.
[15] Poopak MV,Farid B,Mohammad F,et al. Low frequency repetitive transcranial magnetic stimulation to improve motor function and grip force of upper limbs of patients with hemiplegia[J]. Iran Red Crescent Med J, 2014,16(8): e13579.
[16] Choi CM, Kim JH, Lee JK, et al. Effects of repetitive transcranial magnetic stimulation over trunk motor spot on balance function in stroke patients[J]. Ann Rehabil Med, 2016, 40(5):826-834.
[17] Barros G, Silvana C, Borba S, et al. Efficacy of coupling repetitive transcranial magnetic stimulation and physical therapy to reduce upper-limb spasticity in patients with stroke: a randomized controlled trial [J]. Arch Phys Med Rehabil, 2014, 95(2):222-229.
[18] Hosomi K, Morris S, Sakamoto T, et al. Daily repetitive transcranial magnetic stimulation for poststroke upper limb paresis in the subacute period[J]. J Stroke Cerebrovasc Dis, 2016, 25(7):1655-1664.
[19] Hsu WY, Cheng CH, Liao KK, et al. Effects of repetitive transcranial magnetic stimulation on motor functions in patients with stroke: a meta-analysis[J]. Stroke, 2012, 43(7):1849-1857.
[20] Richards LG, Stewart KC, Woodbury ML, et al. Movement-dependent stroke recovery: a systematic review and meta-analysis of TMS and fMRI evidence[J]. Neuropsychologia, 2008, 46(1):3-11.
[21] Sasaki N, Kakuda W, Abo M. Bilateral high- and low-frequency rTMS in acute stroke patients with hemiparesis: a comparative study with unilateral high-frequency rTMS[J]. Brain Inj, 2014, 28(13-14):1682-1686.
[22] Takeuchi N, Tada T, Toshima M, et al. Repetitive transcranial magnetic stimulation over bilateral hemispheres enhances motor function and training effect of paretic hand in patients after stroke[J]. J Rehabil Med, 2009, 41(13):1049-1054.