M1区和小脑区重复经颅磁刺激对卒中后患者下肢的影响

The Effect of Repetitive Transcranial Magnetic Stimulation in the M1 and Cerebellar Areas on Lower Limb Function in Post-Stroke

摘要: 目的：探究重复经颅磁刺激作用于卒中后患者小脑区和M1区对下肢运动、平衡功能及皮层兴奋性的影响和差异性。方法：选取卒中后偏瘫患者39例为研究对象，按照计算机随机分组分为假刺激组、M1组和小脑组，每组13例，干预组进行相应靶点低频重复经颅磁刺激治疗、常规药物及康复治疗，假刺激组除外常规药物及康复治疗，予以假磁刺激治疗。结果：三组患者治疗前FMA-LE量表评分、BBS量表评分、坐站行走测试时间、10米步行测试时间、双侧足底压力对称指数、身体压力中心摆动面积无显著差异(p > 0.05)，治疗后三组患者指标均较治疗前有所改善(p < 0.05)，干预组量表评分均优于假刺激组(p < 0.05)，且小脑组在站立及步行中平衡改善优于假刺激组(p < 0.05)。结论：M1区和小脑区低频rTMS均能有效改善卒中后患者的下肢功能，而小脑区刺激对下肢平衡功能的恢复效果更佳。

Abstract: Objective: To investigate the effects and differences of low-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the cerebellar region and M1 area on lower limb motor function, balance function, and cortical excitability in post-stroke patients. Methods: Thirty-nine hemiplegic patients after stroke were randomly divided into three groups (sham stimulation group, M1 group, and cerebellar group) with 13 cases each. The intervention groups received low-frequency rTMS targeting specific regions combined with routine medication and rehabilitation therapy, while the sham stimulation group received sham magnetic stimulation without routine treatments. Results: No significant differences (p > 0.05) were observed in baseline FMA-LE scores, BBS scores, time up and go Test duration, 10-meter walk test duration, plantar pressure symmetry index, or center of pressure sway area among the three groups. Post-treatment improvements were observed in all groups (p < 0.05), with intervention groups demonstrating superior scale scores compared to the sham group (p < 0.05). The cerebellar group showed better balance improvement during standing and walking than the sham group (p < 0.05). Conclusion: Both M1 and cerebellar low-frequency rTMS effectively improve lower limb function in post-stroke patients, with cerebellar stimulation demonstrating superior efficacy in restoring balance function.