小脑间歇性θ爆发刺激对卒中后下肢功能 和平衡的疗效研究

Therapeutic Effects of Cerebellar Intermittent Theta-Burst Stimulation on Lower-Limb Function and Balance after Stroke

摘要: 目的：探讨针对健侧小脑半球的间歇性θ爆发刺激(iTBS)对脑卒中后患者下肢运动功能及平衡能力的康复疗效及神经生理机制。方法：选取24例脑卒中后下肢功能障碍患者，采用随机、双盲、假刺激对照设计分为试验组(小脑-iTBS)和对照组(假-iTBS)，每组12例。两组均接受常规康复训练，试验组在此基础上对健侧小脑半球实施iTBS干预，对照组给予假刺激，每天1次，每周5天，连续3周。采用Berg平衡量表(BBS)、Fugl-Meyer下肢运动功能评定量表(FMA-LE)及运动诱发电位(MEP)评定疗效。结果：治疗3周后，两组BBS、FMA-LE评分均较治疗前显著提高。组间比较显示，试验组BBS及FMA-LE评分的改善程度显著优于对照组(P < 0.05)。电生理方面，试验组患侧MEP波幅的增幅显著高于对照组(P < 0.05)，但两组间MEP潜伏期无显著差异。结论：在常规康复基础上联合健侧小脑半球iTBS，能更有效地改善脑卒中患者的下肢运动功能与平衡能力，其机制可能与激活小脑–丘脑–皮层通路、增强皮质脊髓兴奋性并促进运动网络重组有关。

Abstract: Objective: To investigate the rehabilitative effects and neurophysiological mechanisms of intermittent Theta-Burst Stimulation (iTBS) targeting the contralesional cerebellar hemisphere on lower-limb motor function and balance in patients after stroke. Methods: Twenty-four post-stroke patients with lower-limb dysfunction were enrolled and randomly assigned to an experimental group (cerebellar iTBS, n = 12) or a control group (sham iTBS, n = 12) in a double-blind, sham-controlled design. Both groups received conventional rehabilitation training. Additionally, the experimental group underwent iTBS over the contralesional cerebellar hemisphere, while the control group received sham stimulation once daily, 5 days per week, for 3 consecutive weeks. Outcomes were assessed using the Berg Balance Scale (BBS), the Fugl-Meyer Assessment for the Lower Extremity (FMA-LE), and Motor-Evoked Potentials (MEPs). Results: After 3 weeks of treatment, BBS and FMA-LE scores increased significantly in both groups compared with baseline. Between-group comparisons showed that improvements in BBS and FMA-LE were significantly greater in the experimental group than in the control group (P < 0.05). Neurophysiologically, the increase in MEP amplitude on the affected side was significantly greater in the experimental group than in the control group (P < 0.05), whereas no significant between-group difference was observed in MEP latency. Conclusion: Adding iTBS over the contralesional cerebellar hemisphere to conventional rehabilitation more effectively improves lower-limb motor function and balance in patients after stroke. The underlying mechanism may involve activation of the cerebello-thalamo-cortical pathway, enhancement of corticospinal excitability, and facilitation of motor network reorganization.