重複性經顱磁刺激對於腦中風患者上肢動作功能影響研究之整合分析   全文下載

The Effect of Repetitive Transcranial Magnetic Stimulation on Upper Extremity Motor Function in Stroke Patients: A Meta-Analytical Review

重複性經顱磁刺激（repetitive transcranial magnetic stimulation, rTMS）是一種非侵襲性的腦部電刺激方法，可以改變運動皮質的興奮性，對於腦中風病人的運動功能障礙，是潛在的治療方法。然而，它對於中風病人上肢運動功能的效果仍然不明。因此，本研究希望藉著系統性文獻回顧，透過整合分析的方式，來評估重複性經顱磁刺激（transcranial magnetic stimulation, rTMS）對於中風患者的上肢動作功能，是否具有療效，並進一步探討刺激模式與效果的關係。本研究搜尋2010年3月底前，使用重複性經顱磁刺激介入腦中風患者的上肢動作功能治療的文獻。檢索的資料庫包括「PubMed」、「SCIRUS」、「Cochrane Library」以及「中文電子期刊服務資料庫」。以Jadad Scale和美國神經學學院治療性研究標準（AANC）評估文獻品值，並以Comprehen-sive meta-analysis version 2.0（Biostat, Englewood, NJ, USA）軟體進行整合分析，共納入9篇文獻進行分析，結果發現，重複性經顱磁刺激治療整體效益值達顯著正向效益（Hedges’g = 0.590, 95% CI = 0.133 - 1.048, p = 0.011）。進一步分析，發現和未使用經顱磁刺激作為介入相比較之下，達顯著正向效益的族群為：急性腦中風患者（Hedges’g = 0.91, 95% CI = 0.339 - 1.481, p = 0.002）以及將低頻重複性經顱磁刺激使用於健側大腦（Hedges’g = 0.807, 95% CI = 0.054 - 1.560, p = 0.036）。本研究結果顯示，低頻重複性經顱磁刺激使用於健側大腦對於急性腦中風患者的上肢功能具有正向效益。"

Repetitive magnetic stimulation (rTMS) is a non-invasive brain stimulation technique, which can alter excitability in the motor cortex and is a potential treatment for motor impairment in stroke patients. However, the effect of rTMS on upper extremity function in stroke patients remains controversial. This study systematically reviewed and meta-analyzed the current findings on the effectiveness of rTMS for restoring upper extremity motor function in stroke patients. A comprehensive literature search up to March 2010 of PubMed, the Cochrane Library, Scirus and the Chinese Electronic Periodical Services (CEPS) was performed. The articles from these searches were used to obtain additional articles. The quality of each study was assessed by criteria suggested by Jadad and the American Academy of Neurology for grading therapeutic trials. Biostat meta-analysis software version 2.0 was used to perform meta-analysis. Nine studies were included. The overall random effects model revealed a significant positive treatment effect of rTMS when applied to primary motor cortex (M1) (Hedges’ g = 0.590, 95% CI = 0.133 - 1.048, p = 0.011). In subgroup analysis, positive treatment effects were seen in acute stroke (Hedges’ g = 0.91, 95% CI = 0.339 - 1.481, p = 0.002) and on the nonlesional M1 cortex (Hedges’ g = 0.807, 95% CI = 0.054 - 1.560, p = 0.036). It is concluded that when applied to the nonlesional hemisphere, low frequency rTMS may improve the upper extremity motor function of patients with acute stroke.