外周联合中枢rTMS促进脑卒中后上肢运动功能康复及研究进展
Peripheral Combined Central rTMS Promotes Upper Limb Motor Function Rehabilitation after Stroke and Research Progress
DOI: 10.12677/acm.2025.1592627, PDF,    科研立项经费支持
作者: 韩文秀：内蒙古医科大学研究生学院，内蒙古 呼和浩特；呼和浩特市中蒙医院物理检查科，内蒙古 呼和浩特；王 博：内蒙古医科大学研究生学院，内蒙古 呼和浩特；包乌兰, 朝木日力格, 王阿茹, 曹塔娜：呼和浩特市中蒙医院物理检查科，内蒙古 呼和浩特；武树青：武树青蒙医诊所，内蒙古 呼和浩特；郝利霞*：内蒙古医科大学附属医院康复科，内蒙古 呼和浩特
关键词: 重复经颅磁刺激；脑卒中；上肢运动功能障碍；Repetitive Transcranial Magnetic Stimulation； Stroke； Upper Extremity Motor Dysfunction
摘要: 重复经颅磁刺激(repetitive transcranial magnetic stimulation, rTMS)是一种无痛、无创的非侵袭性神经电生理技术，近年来主要应用于脑卒中患者认知和运动功能障碍康复、精神病、脊髓损伤等疾病的治疗以及意识障碍患者的促醒治疗，且改善脑卒中患者上肢运动功能的效果已被证实，但目前临床上对外周联合中枢的重复经颅磁刺激研究机制进展还未有定论，严重影响了外周联合中枢的重复经颅磁刺激技术的进一步探索、研究和推广。本文通过综述外周联合中枢的重复经颅磁刺激在脑卒中运动功能康复治疗中的研究进展，并探索外周重复经颅磁刺联合中枢重复经颅磁刺促进脑卒中患者上肢运动功能的恢复的可能机制，以期为脑卒中患者上肢运动功能障碍康复治疗和研究中提供新型的治疗策略和理论依据。
Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a painless, non-invasive and non-invasive neurophysiological technique, which has been mainly used in the rehabilitation of cognitive and motor dysfunction in stroke patients, the treatment of psychiatric diseases, spinal cord injuries and other diseases, as well as the awakening of patients with disorders of consciousness in recent years. In recent years, it has been mainly applied to the treatment of cognitive and motor dysfunction in stroke patients, psychiatric disorders, spinal cord injury and other diseases, as well as to the awakening of patients with consciousness disorder, and the effect of improving the motor function of upper limbs in stroke patients has been confirmed. However, the progress of the research mechanism of the repetitive transcranial magnetic stimulation of the peripheral joint center has not yet been determined, which has seriously affected the further exploration, research and promotion of the repetitive transcranial magnetic stimulation of the peripheral joint center. In this paper, we review the research progress of peripheral and central repetitive transcranial magnetic stimulation in the rehabilitation of stroke motor function, and explore the possible mechanism of peripheral repetitive transcranial magnetic stimulation combined with central repetitive transcranial magnetic stimulation to promote the restoration of upper limb motor function in patients with stroke, with the aim of providing a new type of therapeutic strategy and theoretical basis for the rehabilitation of upper limb motor dysfunction in stroke patients and in the research.
文章引用：韩文秀, 王博, 包乌兰, 朝木日力格, 王阿茹, 曹塔娜, 武树青, 郝利霞. 外周联合中枢rTMS促进脑卒中后上肢运动功能康复及研究进展[J]. 临床医学进展, 2025, 15(9): 1323-1332. https://doi.org/10.12677/acm.2025.1592627

参考文献

[1] Patel, U., Tavrawala, K., Mohammad, Z., et al. (2022) Abstract 13921: Substance Use Disorders and Prevalence of Stroke Amongst the US Population. Circulation, 146, A13921. [Google Scholar] [CrossRef] 
[2] 熊文婧, 徐杰茹, 张敏, 姚承志, 赵湘铃, 吴霞, 让蔚清. 2005-2019年中国脑卒中发病与死亡趋势及未来十年预测[J]. 现代预防医学, 2024(1): 15-20.
[3] Jannati, A., Oberman, L.M., Rotenberg, A. and Pascual-Leone, A. (2023) Assessing the Mechanisms of Brain Plasticity by Transcranial Magnetic Stimulation. Neuropsychopharmacology, 48, 191-208. [Google Scholar] [CrossRef] [PubMed]
[4] 庞瑞丰, 唐强, 宋文婧, 吴民民, 朱路文. 重复经颅磁刺激对帕金森病患者步行能力和平衡功能影响的Meta分析[J]. 中国康复医学杂志, 2024, 39(4): 550-557.
[5] 王美洁, 时亚杰, 杨鹏, 王建军, 李迎寅, 崔健, 张校明. 重复经颅磁刺激或无抽搐电休克治疗联合抗抑郁药物对重度抑郁障碍的疗效和安全性[J]. 四川精神卫生, 2024, 37(2): 108-113.
[6] 单文文, 张红霞, 姜贵贤. 重复经颅磁刺激预防慢性偏头痛的临床疗效和安全性的Meta分析[J]. 医学信息, 2024, 37(9): 48-53.
[7] 黄媛, 林瑞珠, 马良辰, 田富宝, 李泓钰, 朱宁. 双侧半球重复经颅磁刺激对脑卒中恢复期患者上肢运动功能及血清BDNF水平的影响[J]. 宁夏医科大学学报, 2023, 45(4): 376-381+405.
[8] 梁雪琴, 马惠姿, 潘芳芳, 李娜, 段亚男, 张香玉. 高频重复经颅磁刺激结合肢体功能训练对缺血性脑卒中患者神经电生理的影响[J]. 中国实用神经疾病杂志, 2023, 26(4): 460-465.
[9] 薛慧, 王宝军, 刘国荣, 等. 高频及低频重复经颅磁刺激对急性期脑梗死患者运动功能恢复的临床研究[J]. 中国康复医学杂志, 2013, 28(11): 1030-1034.
[10] 吴涛, 李蕴琛, Martin, S., 等. 经颅重复磁刺激对人脑皮层兴奋性的影响[J]. 中华神经科杂志, 2001, 34(1): 40-42.
[11] 靳静娜. rTMS联合运动训练对运动功能及脑网络连接影响的研究[D]: [博士学位论文]. 北京: 北京协和医学院, 2017.
[12] 杨德本, 谢建平, 王晓明. 重复经颅磁刺激对正常人脑血流灌注和速度的影响[J]. 中国临床康复, 2005, 9(37): 50-51.
[13] 王晓明, 谢建平, 黄慧, 等. 正常人重复经颅磁刺激后脑血流速度的变化[J]. 临床神经电生理学杂志, 2003, 12(4): 202-203.
[14] 赵合庆, 孙永安, 戴永萍, 等. 经颅磁刺激对脑缺血大鼠皮层脑源性神经营养因子表达及梗死体积的影响[J]. 中华神经科杂志, 2005, 38(5): 330-331.
[15] 江岩, 杨勇. 经颅磁刺激结合康复治疗对脑卒中偏瘫患者上肢运动功能及神经递质的影响[J]. 中国医学创新, 2025, 22(16): 108-112.
[16] 于洪丽, 徐桂芝, 杨硕, 等. 磁刺激穴位镇疼诱发的脑电信号特征成分及源定位[J]. 中国组织工程研究与临床康复, 2011, 15(9): 1639-1642.
[17] Okabe, S., Hanajima, R., Ohnishi, T., Nishikawa, M., Imabayashi, E., Takano, H., et al. (2003) Functional Connectivity Revealed by Single-Photon Emission Computed Tomography (SPECT) during Repetitive Transcranial Magnetic Stimulation (rTMS) of the Motor Cortex. Clinical Neurophysiology, 114, 450-457. [Google Scholar] [CrossRef] [PubMed]
[18] 杨泉, 陈敬君, 鲍晓, 等. 针灸结合低频重复经颅磁刺激治疗脑梗死运动性失语的临床效果[J]. 中国当代医药, 2020, 27(12): 49-52.
[19] 鲁遥, 王鹏. 经颅磁刺激疗法在脑卒中康复治疗中的研究进展[J]. 中国卫生标准管理, 2024(13): 195-198.
[20] 钱立锋, 金文杰, 朱鑫鑫, 等. 低频重复经颅磁刺激对脑卒中患者上肢运动功能及脑血流的影响[J]. 中国现代医生, 2022, 60(9): 88-92.
[21] 钟立达, 刘惠宇, 鲍晓, 李芳. 小脑重复经颅磁刺激治疗脑卒中后吞咽障碍的疗效观察[J]. 中国康复, 2021, 36(2): 106-108.
[22] 余晖, 宋哲. 重复经颅磁刺激联合认知康复训练治疗脑卒中后认知障碍的临床效果[J]. 中国医药科学, 2021, 11(4): 31-34.
[23] 纪栋起, 武亮, 李欢欢, 靳沙沙, 范维娇. 不同频率的重复经颅磁刺激对脑卒中上肢运动功能恢复的影响[J]. 中国医药导报, 2024, 21(13): 177-180.
[24] 高伟伟, 夏彬, 翟清华, 单秋菊. 重复经颅磁刺激对脑卒中后运动功能障碍的临床研究[J]. 医药论坛杂志, 2023, 44(16): 57-60.
[25] Münchau, A., Bloem, B.R., Irlbacher, K., Trimble, M.R. and Rothwell, J.C. (2002) Functional Connectivity of Human Premotor and Motor Cortex Explored with Repetitive Transcranial Magnetic Stimulation. The Journal of Neuroscience, 22, 554-561. [Google Scholar] [CrossRef] [PubMed]
[26] Shah-Basak, P., Harvey, D.Y., Parchure, S., Faseyitan, O., Sacchetti, D., Ahmed, A., et al. (2020) Brain-Derived Neurotrophic Factor Polymorphism Influences Response to Single-Pulse Transcranial Magnetic Stimulation at Rest. Neuromodulation: Technology at the Neural Interface, 24, 854-862. [Google Scholar] [CrossRef] [PubMed]
[27] 余安康, 张文倩, 杨初燕. 重复经颅磁刺激对脑卒中后上肢运动障碍影响的研究进展[J]. 中国康复医学杂志, 2022, 37(12): 1733-1738.
[28] 王景峰, 秦佳维, 陈培红, 等. 不同频率重复经颅磁刺激对单侧大脑半球脑卒中后吞咽障碍患者吞咽功能、神经功能及血清BDNF水平的影响[J/OL]. 成都医学院学报, 1-12.
http://kns.cnki.net/kcms/detail/51.1705.r.20240307.1921.002.html, 2024-08-14.
[29] 吕亚希, 庞争争, 谭大洲, 周锐. 重复经颅磁刺激结合反复促通疗法对脑卒中后下肢运动功能的影响[J]. 中国康复, 2024, 39(6): 336-339.
[30] 陈丰玲. 高频重复经颅磁刺激对脑梗死患者认知功能及神经电生理的影响[J]. 哈尔滨医药, 2022, 42(3): 105-106.
[31] Gerschlager, W., Siebner, H.R. and Rothwell, J.C. (2001) Decreased Corticospinal Excitability after Subthreshold 1 Hz rTMS over Lateral Premotor Cortex. Neurology, 57, 449-455. [Google Scholar] [CrossRef] [PubMed]
[32] Rizzo, V., Siebner, H.R., Modugno, N., Pesenti, A., Münchau, A., Gerschlager, W., et al. (2004) Shaping the Excitability of Human Motor Cortex with Premotor rTMS. The Journal of Physiology, 554, 483-495. [Google Scholar] [CrossRef] [PubMed]
[33] Maier, M.A. (2002) Differences in the Corticospinal Projection from Primary Motor Cortex and Supplementary Motor Area to Macaque Upper Limb Motoneurons: An Anatomical and Electrophysiological Study. Cerebral Cortex, 12, 281-296. [Google Scholar] [CrossRef] [PubMed]
[34] Zou, F.J., Chen, X.X., Niu, L.C., et al. (2023) Effect of Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia in Acute Stage. Dysphagia, 38, 1117-1127. [Google Scholar] [CrossRef] [PubMed]
[35] Xie, Y.L., Wang, S., Yang, J., et al. (2022) Theta Burst Stimulation versus High-Frequency Repetitive Transcranial Magnetic Stimulation for Poststroke Dysphagia: A Randomized, Double-Blind, Controlled Trial. Medicine, 101, e28576. [Google Scholar] [CrossRef] [PubMed]
[36] 刘浩, 贾延兵, 魏静, 李朵, 汪纯. 重复外周磁刺激在康复治疗中的应用及研究进展[J]. 中国康复医学杂志, 2021, 36(5): 631-637.
[37] Struppler, A., Binkofski, F., Angerer, B., Bernhardt, M., Spiegel, S., Drzezga, A., et al. (2007) A Fronto-Parietal Network Is Mediating Improvement of Motor Function Related to Repetitive Peripheral Magnetic Stimulation: A PET-H2O15 Study. NeuroImage, 36, T174-T186. [Google Scholar] [CrossRef] [PubMed]
[38] 李阳, 陈树耿, 王传凯, 等. 重复外周磁刺激对脑卒中患者上肢痉挛和运动功能的即刻影响[J]. 中国康复理论与实践, 2018, 24(12): 1376-1379.
[39] Struppler, A., Havel, P. and Müller-Barna, P. (2003) Facilitation of Skilled Finger Movements by Repetitive Peripheral Magnetic Stimulation (RPMS)—A New Approach in Central Paresis. NeuroRehabilitation, 18, 69-82. [Google Scholar] [CrossRef] 
[40] 贾杰. “中枢-外周-中枢”闭环康复——脑卒中后手功能康复新理念[J]. 中国康复医学杂志, 2016, 31(11): 1180-1182.
[41] 程期琳. rTMS联合rPMS对脑卒中患者上肢运动功能和皮层兴奋性的影响[D]: [硕士学位论文]. 上海: 上海体育学院, 2023.
[42] 徐丹丹. 中枢联合外周磁刺激对卒中患者上肢屈肌痉挛的影响[D]: [硕士学位论文]. 苏州: 苏州大学, 2022.
[43] Zschorlich, V.R., Hillebrecht, M., Tanjour, T., Qi, F., Behrendt, F., Kirschstein, T., et al. (2019) Repetitive Peripheral Magnetic Nerve Stimulation (rPMS) as Adjuvant Therapy Reduces Skeletal Muscle Reflex Activity. Frontiers in Neurology, 10, Article 930. [Google Scholar] [CrossRef] [PubMed]
[44] Chen, S., Li, Y., Shu, X., Wang, C., Wang, H., Ding, L., et al. (2020) Electroencephalography Mu Rhythm Changes and Decreased Spasticity after Repetitive Peripheral Magnetic Stimulation in Patients Following Stroke. Frontiers in Neurology, 11, Article 546599. [Google Scholar] [CrossRef] [PubMed]
[45] Krewer, C., Hartl, S., Müller, F. and Koenig, E. (2014) Effects of Repetitive Peripheral Magnetic Stimulation on Upper-Limb Spasticity and Impairment in Patients with Spastic Hemiparesis: A Randomized, Double-Blind, Sham-Controlled Study. Archives of Physical Medicine and Rehabilitation, 95, 1039-1047. [Google Scholar] [CrossRef] [PubMed]
[46] Obayashi, S. and Takahashi, R. (2020) Repetitive Peripheral Magnetic Stimulation Improves Severe Upper Limb Paresis in Early Acute Phase Stroke Survivors. Neuro Rehabilitation, 46, 569-575. [Google Scholar] [CrossRef] [PubMed]
[47] Kinoshita, S., Ikeda, K., Hama, M., Suzuki, S. and Abo, M. (2020) Repetitive Peripheral Magnetic Stimulation Combined with Intensive Physical Therapy for Gait Disturbance after Hemorrhagic Stroke: An Open-Label Case Series. International Journal of Rehabilitation Research, 43, 235-239. [Google Scholar] [CrossRef] [PubMed]
[48] Lo, Y.L., Fook-Chong, S., Huerto, A.P. and George, J.M. (2011) A Randomized, Placebo-Controlled Trial of Repetitive Spinal Magnetic Stimulation in Lumbosacral Spondylotic Pain. Pain Medicine, 12, 1041-1045. [Google Scholar] [CrossRef] [PubMed]
[49] Yambe, T., Inoue, A., Sekine, K., Shiraishi, Y., Watanabe, M., Yamaguchi, T., et al. (2005) Effect of the Alternative Magnetic Stimulation on Peripheral Circulation for Regenerative Medicine. Biomedicine & Pharmacotherapy, 59, S174-S176. [Google Scholar] [CrossRef] [PubMed]
[50] Sasaki, N., Kakuda, W. and Abo, M. (2014) Bilateral High-and Low-Frequency rTMS in Acute Stroke Patients with Hemiparesis: A Comparative Study with Unilateral High-Frequency rTMS. Brain Injury, 28, 1682-1686. [Google Scholar] [CrossRef] [PubMed]
[51] 郑娅, 许东升. 多靶区协同增强神经环路调控: 思考与创新[J]. 四川大学学报(医学版), 2020, 51(5): 587-591+582.
[52] 杨昌霞. 高、低频rTMS治疗脑卒中后运动功能障碍的疗效对比及功能网络研究[D]: [硕士学位论文]. 泸州: 西南医科大学, 2018.
[53] 张永卿. 经颅联合外周磁刺激对脑卒中患者上肢运动功能及日常生活活动能力的影响[D]: [硕士学位论文]. 蚌埠: 蚌埠医学院, 2023.
[54] Rossi, S., Hallett, M., Rossini, P.M. and Pascual-Leone, A. (2009) Safety, Ethical Considerations, and Application Guidelines for the Use of Transcranial Magnetic Stimulation in Clinical Practice and Research. Clinical Neurophysiology, 120, 2008-2039. [Google Scholar] [CrossRef] [PubMed]
[55] 徐榕, 朱光跃, 王勇, 等. 外周磁刺激结合经颅磁刺激对脑卒中后上肢痉挛的影响[J]. 中国康复医学杂志, 2021, 36(8): 943-948.
[56] 俞风云, 朱玉连, 梁思捷, 等. 经颅和外周磁刺激治疗脑卒中后上肢运动功能障碍的随机对照研究[J]. 中国康复医学杂志, 2021, 36(5): 538-545.
[57] 严晶晶, 袁海峰, 张妮, 等. 中枢联合外周重复磁刺激对卒中后运动功能障碍的疗效[J]. 华西医学, 2021, 36(5): 588-594.
[58] 夏菁, 郝又国, 陈缪存, 等. 高频重复经颅磁刺激结合外周磁刺激治疗脑卒中后肌痉挛的临床研究[J]. 神经损伤与功能重建, 2022, 17(8): 478-481.
[59] Yang, T., Li, X., Xia, P., et al. (2023) Effects of rTMS Combined with rPMS on Stroke Patients with Arm Paralysis after Contralateral Seventh Cervical Nerve Transfer: A Case-Series. International Journal of Neuroscience, 133, 999-1007.
[60] Cavinato, M., Iaia, V. and Piccione, F. (2012) Repeated Sessions of Sub-Threshold 20-Hz rTMS. Potential Cumulative Effects in a Brain-Injured Patient. Clinical Neurophysiology, 123, 1893-1895. [Google Scholar] [CrossRef] [PubMed]

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