重複經顱磁刺激對急性後期照護的腦中風患者的臨床效益

研究目的近年來重複經顱磁刺激（repetitive transcranial magnetic stimulation, rTMS）為被廣泛應用之非侵入性腦刺激術，目前已證實在亞急性期中風患者給予對側腦部運動皮質（contralesional primary motor cortex, M1）低頻刺激以改善手部功能；重鬱症患者給予左側背外側前額葉皮質（dorsolateral prefrontal cortex, DLPFC）高頻刺激以改善情緒症狀，確定有效（definite efficacy, level A）。此外，越來越多研究證實西塔叢集刺激（theta burst stimulation, TBS）相對於標準重覆經顱磁刺激的治療效果相當，但效率更好。本研究旨在探討急性後期照護的腦中風住院患者（stroke patients with post-acute care）接受西塔叢集刺激後，能否增進復健成效。研究方法研究回顧收錄共有受測急性後期照護的中風患者有81位，其中實驗組共有22位受測者，接受西塔叢集刺激加上中風住院復健；對照組共有59位，接受中風住院復健。西塔叢集刺激組給予左側背外側前額葉皮質的間歇性西塔叢集刺激（intermittent theta burst stimulation, iTBS）以及對側腦部運動皮質的連續性西塔叢集刺激（continuous theta burst stimulation, cTBS），每天一次，連續十天的療程。兩組受測者皆接受為期六週的復健治療。於入院日、第三週、第六週使用急性後期照護的腦中風臨床量表進行評估。研究結果在完成六週的復健治療及十次的重覆經顱磁刺激治療之後，重覆經顱磁刺激組及對照組的健康相關生活品質評估、傅格梅爾上肢評估量表及伯格氏平衡量表分數在第六週均有比基準評估時改善（p < 0.05）。值得注意的是其中，重覆經顱磁刺激組的伯格氏平衡量表分數有正面趨勢（第三週β= 1.28, p= 0.3642；第六週β= 0.53, p=0.7629）。結論本篇回溯性研究對於亞急性「急性後期照護」的中風住院患者，發現復健治療再加上重覆經顱磁刺激的復健成效，統計結果顯示組間並沒有明顯的差異，但其中伯格氏平衡量表分數有正面趨勢。

ObjectiveRepetitive transcranial magnetic stimulation (rTMS) has emerged as a widely used non-invasive brain stimulation technique in recent years. Evidence-based medicine has demonstrated its efficacy in improving hand function by applying low-frequency stimulation to the contralesional primary motor cortex (M1) in patients with subacute stroke. Similarly, high-frequency stimulation of the left dorsolateral prefrontal cortex (DLPFC) has proven effective (definite efficacy, level A) in treating depression. Additionally, an increasing number of studies have confirmed that theta burst stimulation (TBS) achieves comparable therapeutic effects with enhanced efficiency to standard rTMS. This research aims was to investigate whether TBS could enhance rehabilitation outcomes in stroke patients with post-acute care.Methods and MaterialsThis retrospective study enrolled 81 stroke patients with post-acute care, of whom 22 participants receiving TBS along with stroke inpatient rehabilitation (rTMS group) whereas 59 participants receiving the rehabilitation program alone (control group). The rTMS group subjects have received intermittent theta burst stimulation (iTBS) to the left DLPFC area and continuous theta burst stimulation (cTBS) to the contralesional primary motor cortex once daily for ten days (5times weely). Both groups underwent six weeks long rehabilitation program. The various post-acute care clinical scales were used to assess all participants at admission, week 3, and week 6.ResultsAfter completing six weeks long rehabilitation programs, both the rTMS group and the control group showed significant improvements scored either by health-related quality of life assessments, Fugl-Meyer Upper Extremity Assessment Scale scores, or Berg Balance Scale scores at week 6 compared to baseline (p < 0.05). However, no significant difference in various score changes between the two groups, except that the rTMS group exhibited a positive trend in Berg Balance Scale scores (week 3 β= 1.28, p= 0.3642; week 6 β= 0.53, p= 0.7629).ConclusionThis retrospective study on subacute stroke patients with post-acute care revealed that rehabilitation treatment combined with rTMS yielded no significant intergroup differences in rehabilitation outcomes. However, a positive trend was observed in the Berg Balance Scale scores, suggesting potential benefits of rTMS in this domain.