經顱直流電刺激合併神經肌肉電刺激對於中風病人大腦皮質興奮性的立即效應：初步研究

Immediate Effects of Transcranial Direct Electrical Stimulation Combined With Neuromuscular Electrical Stimulation on Cortical Excitability in Patients With Stroke: A Preliminary Study

鄭崴璟(Wei-Jing Chen) ； 魏雅瑩(Ya-Ying Wei) ； 葉哲宇(Zhe-Yu Ye) ； 蕭世芬(Shih-Fen Hsiao) ； 許妙如(Miao-Ju Hsu) ； 林昭宏(Jau-Hong Lin)

《物理治療》 47卷2期 (2022/06) Pp. 60-72

https://doi.org/10.6215/FJPT.202206_47(2).0002

摘要

背景與目的：先前研究已分別證實經顱直流電刺激（transcranial direct current stimulation, tDCS）與神經肌肉電刺激（neuromuscular electrical stimulation, NMES）對於中風患者上肢功能恢復的效益。本研究探討tDCS合併NMES對於大腦動作皮質興奮性變化的立即效應。方法：徵召29位首次發病超過六個月缺血性中風患者並隨機分派至tDCS合併NMES組（9位）、tDCS組（11位）或對照組（9位）其中一組，每位受試者分別接受30分鐘不同組合的刺激介入。介入前和介入後每位受試者均接受單次脈衝經顱磁刺激（transcranial magnetic stimulation）施測，以分析介入前後其雙側大腦皮質動作誘發電位（motor-evoked potentials, MEP）的改變情形。MEP改變量增加或減少大於0.015 mV暨最小真實變化值（smallest real difference）代表有實質性變化。結果：三組之受試者各有8名完成實驗介入及前後施測評估；其中，共有9位（每組各3名）受試者（皆占37.5%）之損傷大腦皮質區域MEP在介入前後改變量增加大於最小真實變化值0.015 mV。此外，在健側腦，有7名受試者刺激介入前後MEP改變減少值大於最小真實變化值，其中單獨tDCS組有4名受試者（占50%）明顯比較多於tDCS合併NMES組2名（25%）和對照組1名（12.5%）。結論：初步研究結果尚無法支持30分鐘tDCS合併NMES介入模式能夠立即有效增加損傷大腦動作皮質興奮性及抑制健側大腦動作皮質區興奮性之效應。未來的研究需要招募更多的受試者並探討tDCS合併NMES最佳介入組合的模式。

關鍵字

動作誘發電位 ； 神經肌肉電刺激 ； 中風 ； 經顱直流電刺激 ； 經顱磁刺激

並列摘要

Background and Purpose: Transcranial direct current stimulation (tDCS) and neuromuscular electrical stimulation (NMES) have both been proven effective on its own for promoting upper extremity motor recovery in stroke patients. The aim of this study was to investigate the immediate effects of tDCS combined with NMES on excitability of motor cortex in patients with stroke. Methods: Twenty-nine subjects with first-ever ischemic stroke for more than six months were randomly assigned to one of the three groups: tDCS combined with NMES group (n = 9), tDCS group (n = 11), or control group (n = 9). All participants received a 30-minute intervention protocol. Motor threshold and motor evoked potentials from both hemispheres were assessed by single-pulse transcranial magnetic stimulation for investigating the changes on cortical excitability before and after the intervention. An increase or decrease in motor-evoked potentials (MEP) bigger than the smallest real difference (0.015 mV) was considered as a substantial change. Results: Eight participants in each group completed the interventions and assessments. After the intervention, there were 9 subjects (3 in each group, 37.5%) showing increased MEP (more than 0.015 mV) of the affected hemisphere. In addition, decreased MEP (more than 0.015 mV) was found in the non-affected hemisphere from 7 subjects, with 4 of them (50%) from the tDCS alone group, 2 from the combined group (25%) and 1 from the control group (12.5%). Conclusion: Our preliminary finding was yet to support the immediate effect of 30-minute combined tDCS and NMES intervention in increasing the cortical excitability in affected hemisphere and inhibiting the cortical excitability in non-affected hemisphere. It is crucial to recruit more subjects in the future study to identify optimal mode for such intervention.

並列關鍵字

Motor evoked potential ； Neuromuscular electrical stimulation ； Stroke ； Transcranial direct current stimulation ； Transcranial magnetic stimulation