低频、高频重复经颅磁刺激治疗卒中后上肢痉挛临床疗效的回顾性分析

A Retrospective Analysis of the Clinical Efficacy of Low-Frequency and High-Frequency Repetitive Transcranial Magnetic Stimulation in the Treatment of Upper Limb Spasticity after Stroke

摘要: 目的：本研究通过回顾性队列研究探讨不同频率重复经颅磁刺激(rTMS)对卒中后上肢痉挛的干预效果。方法：收集纳入2022年1月至2025年1月于重庆医科大学附属第二医院神经内科、康复医学科治疗的60例卒中后上肢痉挛患者病历资料，根据治疗方式随机分为低频rTMS组(1 Hz健侧M1区，n = 20)，高频rTMS组(10 Hz患侧M1区，n = 20)和常规康复治疗组(n = 20)；三组均接受常规康复治疗(包括肌肉牵伸、关节活动训练、神经发育疗法、物理因子治疗、任务导向训练等)，疗程8周。评估指标包括主要观察指标(上肢各肌群痉挛程度，采用改良Ashworth量表评定)和次要指标(上肢运动功能，采用Fugl-Meyer评定量表评定；日常生活活动能力，采用改良Barthel指数评定)。结果：治疗前，三组患者基线资料无显著差异。治疗4周及8周后，低频rTMS组和高频rTMS组MAS、FMA-UE和MBI评分与常规康复组同一时间点比较均显著改善(P < 0.05)；低频组在各肌群MAS评分改善方面更占优势，而高频组FMA-UE评分提升更显著(P ≈ 0.05)。结论：不同靶点的低频和高频rTMS治疗均可有效改善卒中后上肢痉挛程度、运动功能和日常生活活动能力；低频rTMS刺激更适用于痉挛控制，而高频rTMS更利于改善运动功能。但本次研究过程中可能存在选择偏倚，且缺乏长期随访数据，无法观察远期疗效。

Abstract: Objective: This study explored the intervention effects of repetitive transcranial magnetic stimulation (rTMS) at different frequencies on upper limb spasticity after stroke through a retrospective cohort study. Methods: The medical records of 60 patients with post-stroke upper limb spasticity treated in the Department of Neurology and Department of Rehabilitation Medicine of the Second Affiliated Hospital of Chongqing Medical University from January 2022 to January 2025 were collected and included. According to the treatment methods, they were randomly divided into low-frequency rTMS group (1 Hz on the healthy side M1 area, n = 20), high-frequency rTMS group (10 Hz on the affected side M1 area, n = 20), and conventional rehabilitation treatment group (n = 20). All three groups received conventional rehabilitation treatment (including muscle stretching, joint movement training, neurodevelopmental therapy, physical factor therapy, task-oriented training, etc.) for 8 weeks. The assessment indicators included the primary observation index (the degree of spasticity of each muscle group in the upper limb, evaluated by the modified Ashworth scale) and secondary indicators (upper limb motor function, evaluated by the Fugl-Meyer assessment scale; activities of daily living, evaluated by the modified Barthel index). Results: Before treatment, there were no significant differences in baseline data among the three groups of patients. After 4 and 8 weeks of treatment, the MAS, FMA-UE and MBI scores of the low-frequency rTMS group and the high-frequency rTMS group were significantly improved compared with those of the conventional rehabilitation group at the same time points (P < 0.05); the low-frequency group had a greater advantage in the improvement of MAS scores in each muscle group, while the high-frequency group had a more significant increase in FMA-UE scores (P ≈ 0.05). Conclusion: Low-frequency and high-frequency rTMS treatments targeting different brain regions can both effectively alleviate the severity of upper limb spasticity, improve motor function and daily living activities after stroke. Low-frequency rTMS stimulation is more suitable for spasticity control, while high-frequency rTMS is more conducive to improving motor function. However, there might be selection bias in this study process, and there is a lack of long-term follow-up data, making it impossible to observe the long-term efficacy.