經顱直流電刺激合併神經肌肉電刺激於健康人動作皮質興奮性的立即效果：先導型研究

Immediate effects of Transcranial Direct Current Stimulation Combined with Neuromuscular Electrical Stimulation on Corticomotor Excitability in Healthy Adults: A Pilot Study

林芳瑾(Fang-Jing Lin)

指導教授 ： 林昭宏

高雄醫學大學/健康科學院/物理治療學系碩士班/碩士(2016年)

摘要

研究背景與研究目的：許多研究驗證經顱直流電刺激(transcranial direct current stimulation, tDCS)結合不同的治療方式的療效。然而，缺少研究探討tDCS與神經肌肉電刺激(neuromuscular electrical stimulation, NMES)合併使用的模式與成效。本先導型研究目的評估tDCS合併NMES是否能夠改變主要動作皮質興奮性，並探討安全性與可行性。研究方法：徵招右慣用手年輕健康受試者，每位受試者皆接受一次30分鐘tDCS合併NMES刺激。tDCS電流強度設定2毫安培(mA)，陽極和陰極分別擺放於非慣用腦右腦和慣用腦左腦主要動作皮質區；NMES強度設定在10~20mA範圍，頻率50Hz，波寬200μs，作用期/休息期：10秒/10秒，刺激非慣用手左手橈側伸腕肌與伸指總肌。介入前後各別進行單次脈衝經顱磁刺激施測，記錄前後雙側大腦皮質動作閾值、動作誘發電位與動作區域大小的改變。研究結果：共徵招15位受試者完成實驗，過程中所有個案都沒有發生不適症狀或副作用。介入前後，左右腦之動作閾值皆下降(0.27±0.80%與0.47±0.63%)，左右腦之動作誘發電位皆上升(0±0.02mV與0.08±0.04mV)，左右腦之動作區域皆增加(0.73±1.41個與2.07±1.85個)。然而，雙側大腦的三項參數值改變量皆未達到統計上顯著性差異。結論：30分鐘tDCS合併NMES刺激介入方式具安全性及可行性，對於年輕健康受試者雙側大腦動作皮質區產生神經生理變化即時效應，但尚未達到顯著性活化興奮的效果。臨床意義：初步結果可以提供未來應用tDCS合併NMES刺激介入臨床中風病人上肢動作恢復治療計劃的參考。

關鍵字

刺激 ； 誘發電位 ； 神經生理 ； 中風

並列摘要

Background and purpose: Several studies demonstrated the effects of transcranial direct current stimulation (tDCS) combined with other treatments. However, the mode and the effect of tDCS combined with neuromuscular electrical stimulation (NMES) have not yet investigated. Therefore, the purpose of this pilot study was to investigate the immediate effect of tDCS combined with NMES on corticomotor excitability as well as the safety and feasibility. Methods: Young healthy subjects with right-handedness were recruited. Subjects received a 30-minute tDCS combined with NMES interventions. For delivering tDCS, the anodal /cathodal electrode was placed on non-dominant (right brain)/dominant (left brain) primary motor cortex, with a constant direct current of 2 mA intensity applied. The NMES stimulus intensity, frequency, pulse duration, and duty cycle were set at 10~20 mA, 50Hz, 200μs, 10sec on and 10sec off, respectively. The electrodes were placed over the extensor carpi radialis and extensor digitorum communis of the non-dominant (left) hands. Single pulse transcranial magnetic stimulation parameters including motor threshold (MT), motor evoked potential (MEP) and size of cortical motor output map (map size) from both hemispheres were assessed for the changes on cortical excitability before and after the intervention. Results: A total of fifteen young healthy subjects participated in the study. No adverse events or side effects were noted in any of the participants during the intervention or the assessment. The decreased MT (0.27±0.80% and 0.47±0.63%), increased MEP (0±0.02mV and 0.08±0.04mV), and increased map size (0.73±1.41 numbers and 2.07±1.85 numbers) were found on the left and right hemisphere after the tDCS combined with NMES intervention. However, the results showed no significant differences in the change scores of both hemispheres. Conclusion: The findings suggest that the 30-minutes tDCS combined with NMES intervention is safe and feasible. The intervention could immediately induce neurophysiologic changes on the motor cortex of the both hemispheres in young healthy subjects, but did not activate obvious corticomotor excitability. Clinical implication: The preliminary findings may provide a reference for using a combination of tDCS and NMES to facilitate upper extremity motor recovery in stroke patients in the future.

並列關鍵字

Stimulation ； Evoked potentials ； Neurophysiology ； Stroke

參考文獻

1. 阮啟弘, 呂岱樺, 陳巧雲. (2005). 跨顱磁刺激在認知神經科學研究的角色. 應用心理研究(28), 51-74.

2. 林立峰, 朱唯勤, 胡名霞. (2003). 由三種功能性神經造影看中風患者之動作恢復機制. 物理治療, 28(4), 217-225.

3. 喬慧燕, 阮啟弘. (2014). 經顱磁刺激及經顱直流電刺激於認知神經科學與復健醫療之應用. 物理治療, 39(1), 1-9.

4. Agnew, W. F., & McCreery, D. B. (1987). Considerations for safety in the use of extracranial stimulation for motor evoked potentials. Neurosurgery, 20(1), 143-147.

5. Agnew, W. F., Yuen, T. G., & McCreery, D. B. (1983). Morphologic changes after prolonged electrical stimulation of the cat's cortex at defined charge densities. Exp Neurol, 79(2), 397-411.