基於數學統計運算分析及圖像化界面腦波分析工具應用於腦中風之腦波在經顱磁刺激後其健側與患側中運動閾值與經顱磁刺激誘發電位間關係探討與分析

EEG Analysis for Discussion of relationship between MT of TMS and TEP in healthy hemisphere and lesioned hemisphere in stroke after Transcranial Magnetic Stimulation Based on Mathematical Statistical Operational analysis and Graphical-interface EEG-analyzing Instrument

林煜軒(Yu-Syuan Lin)

指導教授 ： 陳中平

國立臺灣大學/電機資訊學院/生醫電子與資訊學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202104347

摘要

腦中風是一種由各項原因使腦部組織缺血引發的疾病，因為腦中風發生在中樞神經系統，這容易導致各類像認知障礙、尿失禁、運動障礙等後遺症，目前腦中風與其後遺症已成為全球人類主要的死亡或殘疾原因之一，所造成的生活成本也強烈影響患者、家屬與其他相關人員的生活質量，因此如何預防、診斷、治療中風，及對腦中風患者的復健與照護已成為全球專注的重要議題，目前中風的治療方式有藥物、手術與經顱磁刺激等，其中經顱磁刺激在中風治療上有非侵入式，無痛且有效等優點，但目前臨床上缺乏可行的生物標的診斷與評估腦中風患者的嚴重程度與癒後反應，本次研究我們假設經顱磁刺激誘發電位與其組成具有成為臨床上中風診斷與評估之生物標的潛力，同時該電位和根據經顱磁刺激的運動閾值所設定的刺激強度有關，為了證明這點，本研究招募了31位單側腦中風患者並分別在患者兩側半球上進行臨床經顱磁刺激實驗，同時蒐集實驗進行時患者的腦電波數據，然後分析以取得經顱磁刺激誘發電位組成之振幅，並將該振幅與經顱磁刺激運動閾值一起進行相關性分析，我們從結果中得知不管在病人的健康半球或患病半球中，經顱磁刺激誘發電位組成振幅與經顱磁刺激運動閾值間都呈負相關，表示在兩側半球中較高的經顱磁刺激運動閾值出現時，經顱磁刺激誘發電位組成振幅較低，根據相關研究推測，由於中風後健康半球的代償性作用會阻礙患者治療後的患病半球恢復，因此在健康半球中高運動閾值時低誘發電位組成振幅存在，代表癒後反應良好，但該現象出現在患病半球時代表該半球恢復狀態較差，屬於不良癒後反應，最後，由於在兩側半球中，二者之間呈現負相關，意味著兩者有明確相關性，代表經顱磁刺激誘發電位與其組成有潛力成為臨床上中風診斷與評估之生物標的。

關鍵字

腦中風 ； 腦電圖 ； 經顱磁刺激 ； 經顱磁刺激誘發電位 ； 經顱磁刺激運動閾值 ； 相關性 ； 生物標的

並列摘要

A stroke is a medical condition caused by ischemia of brain tissue due to various reasons. It easily leads to various sequelae such as cognitive impairment, urinary Incontinence, movement disorders because stroke occurs in the central nervous system. Stroke and its sequelae have already become one of main causes of death or disability in global and the cost of living strongly effects the quality of life of patients, family members and other related personnel nowadays. Therefore, the prevention, diagnosis, and treatment of stroke as well as rehabilitation and care of stroke patients have become an important issue focused by people in global. The current treatment of stroke is drug, surgery and transcranial magnetic stimulation(TMS). The TMS as a therapy of stroke has advantage like non-invasive, painless and effective, but there is no any reliable biomarker for diagnosis of severity and assessment of prognosis of stroke patients in clinical. In this study, we assume that TMS-evoked potential(TEP) and its components have the potential to become the biomarker for diagnosis and assessment of stroke in clinical and TEP is associated with intensity of stimulation depend on motor threshold(MT) of TMS at same time. In order to prove this point, we would recruit 31 patients with stroke at one hemisphere in brain and performed clinical transcranial magnetic stimulation experiments on both hemispheres of the patients respectively. We collected the EEG data of patients during experiment and then we would analyze the EEG data to obtain the amplitude of components of TEP. After previous steps, we performed correlation analysis between the amplitude of components of TEP and the MT of TMS. We realize that the correlation between the amplitude of components of TEP and the MT of TMS is negative correlation both in contralesional hemisphere and ipsilesional hemisphere of brain from results. It means that when the MT of TMS is high both in two hemispheres of brain, the amplitude of components of TEP is low. According to related studies, we speculate that because the compensatory effect in healthy hemisphere of brain after stroke will hinder the recovery of ill hemisphere of brain after treatment of patient, the existence of low amplitude of components of TEP when the MT of TMS is high in healthy hemisphere means the prognosis is good, but the same phenomenon appears in ill hemisphere means the worse recovery. It means the prognosis is poor. Finally, because the correlation between the amplitude of components of TEP and the MT of TMS is negative correlation both in two hemispheres of brain, it means the correlation between both is significant. It means the TEP and its components have the potential to become the biomarker for diagnosis and assessment of stroke in clinical.

並列關鍵字

Stroke ； EEG ； Transcranial magnetic stimulation(TMS) ； TMS-evoked potential(TEP) ； Motor threshold(MT) of TMS ； Correlation ； Biomarker

參考文獻

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