磁場刺激單側腦皮質下中風忠者復原期之快速傳導路徑反應波之變化

Magnetic Stimulation of Short Latency Cortical Pathway in Recovery Stage of Unilateral Subcortical Stroke

楊百嘉(Baii-Jia Yang) ； 蘇王麟(Wang-Lin Su) ； 魏大森(Dah-Sen Wei)

《中華民國復健醫學會雜誌》 21期 (1993/12) Pp. 7-13

摘要

正常人腦皮質運動區，以磁場在頭顱外刺激可誘發運動神經快速傳導徑之快速潛期反應(short latency response)，而在對側手，足肌肉記錄到複合肌肉運動電位(CMAP)，並可測量其傳導速度及振幅。
12位初次腦皮質下中風導致明顯半身麻痺且有良好復原之患者，由於一直覺得手、足仍較笨拙，且有無力感，所以對此12位患者測量由頭至手及足之快速運動神經傳導速度，以求了解其腦部運動傳導之情形。這12位患者(11位男性，1位女性)平均年齡為54.8±9.3歲，其腦部病灶位置為基底核，等鄰近區域。6位為出血性病變，另6位為缺血性病變。自中風發生至受測間隔為19.7±23.3個月。測量由大腦至雙手第一背側骨間肌，及至雙足伸趾短肌(EDB)之傳導潛期及CAMP之振幅。
在正常側大腦做磁場刺激所得之快速運動神經傳導至FDI為21.7±1.3msec。而其CMAP之振幅在大部份患者之患側皆比健側小，但有4位其患側有特別變大之現象。
結論：(1)中風患者手足有功能者可以測得運動神經快速反應波之出現。(2)中風患者手、足之笨拙感或無力感可能與快速運動神經傳導之延遲及CMAP振幅之改變有關。

並列摘要

SMagnetic stimulation applied to the scalp over the normal motor cortex caused short latency response of contralateral limb muscles. 12 patients with unilateral subcortical stroke for the first time were selected. They had hemiparesis and good motor recovery up to individual finger movements, although mild weakness and clumsiness of affected limbs were still complainted of. Of the twelve patients (eleven men and one woman) the mean age were 54.8±9.3 years. Lesion sites included basal ganglia, thalamus and corona radiata, with six hemorrhage and six infarction. Time since stroke onset to magnetic stimultation were 19.7±23.3 months. Motor conduction latencies from cortex to bilateral first dorsal interossei and extensor digitorum brevis were recorded.
The latency of normal short latency response over the unaffected motor cortex were 21.7±1.3 msec in FDI and 39.7±4.8 msec in EDB. Stimulation of the affected cortex showed significantly delayed motor conduction latencies than unaffected side in FDI (23.5±2.5 msec) and EDB (42.0±8.6 msec). The amplitude of cortical motor action potential in most cases of the affected limbs were smaller but some are larger than normal.
In conclusion, the short latency response can be found in the stroke patients with motor recovery to individual movement stage. That infered the correlation between fine motor control and short latency cortical pathway. The latency delay of short latency response and amplitude decrease in CMAP might explain the mild clumsiness and weakness of patients. The mechanism of CMAP amplitude over-shooting in some affected side needs further investigation.

並列關鍵字

Magnetic stimulation ； subcortical stroke ； short latency cortical path way