Publication: Kronik dönemdeki iskemik inmeye bağlı hemplejik hastalarda repetitif transkranial manyetik stimülasyonun beyindeki reorganizasyon sürecine ve elektrofizyolojik parametrelere etkisi
Abstract
Kronik dönemdeki iskemik inmeye bağlı hemiplejik hastalarda repetitif transkranial manyetik stimülasyonun beyindeki reorganizasyon sürecine ve elektrofizyolojik parametrelere etkisi Engin ÇAKAR Bu çalışmada, kronik hemiplejik hastalarda transkraniyal manyetik stimülasyon (TMS) ile elde edilen motor uyandırılmış potansiyel (MUP) yanıtları ile klinik parametreler arasındaki ilişkiler ve repetitif TMS (rTMS) uygulamasının beyindeki reorganizasyonel sürece, klinik ve elektrofizyolojik parametrelere etkileri ile elektrofizyolojik parametrelerin prognostik değerleri incelenmiştir. Değerlendirilen 148 hastadan uygun bulunan 23 hasta ile başlanmış ve 20 hasta ile çalışma tamamlanmıştır. Klinik değerlendirme Barthel indeksi, Brunnstrom evrelemesi, Ashworth skalası, Motricity indeksi, parmak vurum sayımı ve motor aktivite izlemi-28 ile, elektrofizyolojik değerlendirme MUP latansı, MUP amplitüdü, istirahat motor eşiği (iME) ve santral motor iletim zamanı (SMİZ) ile yapılmıştır. Tüm hastalar beyin fonksiyonel manyetik rezonans görüntüleme ile değerlendirilmiştir. Hastalar gerçek ve taklit rTMS uygulanmak üzere randomize olarak iki gruba ayrılmıştır. Gerçek rTMS grubunda sağlam hemisfere parabolik koil ile 1 Hz frekansla, %90 iME şiddette 20 dakika (1200 atım) süre ile 5 gün rTMS uygulanmıştır. Başlangıç değerlendirmesinde motor ve fonksiyonel durum ile MUP latansı, iME, SMİZ arasında negatif, MUP amplitüdü arasında pozitif ilişki saptanırken spatisite ile MUP amplitüdü arasında negatif ilişkili bulunmuştur. Gerçek rTMS grubunda klinik ve elektrofizyolojik olarak daha belirgin gelişme olmuş ve bu gelişme kontrol grubuna kıyasla Brunnstrom üst ekstremite motor gelişiminde istatistiksel olarak anlamlı düzeye erişmiştir. Yine bu grupta spastistede anlamlı gerileme olmuştur. Prognostik açıdan spastisite için iME, motor gelişim için SMİZ değerli sonuçlar vermiştir. Sonuç olarak, TMS ile elde edilen elektrofizyolojik parametreler ile klinik durum ve gelişim arasında anlamlı ilişki saptanmıştır ve bu parametreler kronik dönemde prognoz tayini ve izlemde umut verici bulunmuştur. Ayrıca, rTMS uygulamalarının inme rehabilitasyonunda giderek önem kazanacağı düşünülmektedir. nme, motor uyandırılmış potansiyel, transkraniyal manyetik stimülasyon, nörorehabilitasyon
The effect of repetitive transcranial magnetic stimulation on brain reorganization and electrophysiological parameters in chronic stroke Engin ÇAKAR The objective of this study was to investigate the relationships between motor evoked potential (MEP) responses which were evoked by transcranial magnetic stimuation (TMS) and clinical parameters, and to investigate the effects of repetitive TMS (rTMS) on reorganization and on clinical and electrophysiological parameters, and to analyze prognostic value of electrophysiological parameters. 148 patients were assessed, 23 were recruited and 20 finished the trial. Brunnstrom motor staging, Ashworth scale, Motricity index, finger tapping, motor activity log-28, MEP latency, amplitude, resting motor threshold (rMT), central motor conduction time (CMCT) and functional magnetic resonans imaging were used for assessment and follow-up. The patients were randomized to two groups (real rTMS, sham rTMS) and rTMS was applied for five consecutive days (1 Hz, %90 rMT, 20 minute). Motor and functional status were negatively correlated with MEP latency, rMT, CMCT, and were positively correlated with MEP amplitude, and spasticity was negatively correlated with MEP amplitude at baseline evaluation. There were better clinical and electrophysiological improvements in rTMS group and it was statistically better than sham group in regard to Brunnstrom upper extremity stage. There was significant decrease in spasticity in real rTMS group. rMT for spasticity and CMCT for motor improvement were found as hopeful parameters for prognosis determination. In conclusion, TMS evoked electrophysiological parameters had significant correlation with clinical status and improvement, and they were suggestive parameters for prognosis determination and follow-up. Additionally, it was considered that rTMS applications will continue to attract the attentions as a novel therapeutic approach for stroke rehabilitation. stroke, motor evoked potential, transcranial magnetic stimulation, neurorehabilitation
The effect of repetitive transcranial magnetic stimulation on brain reorganization and electrophysiological parameters in chronic stroke Engin ÇAKAR The objective of this study was to investigate the relationships between motor evoked potential (MEP) responses which were evoked by transcranial magnetic stimuation (TMS) and clinical parameters, and to investigate the effects of repetitive TMS (rTMS) on reorganization and on clinical and electrophysiological parameters, and to analyze prognostic value of electrophysiological parameters. 148 patients were assessed, 23 were recruited and 20 finished the trial. Brunnstrom motor staging, Ashworth scale, Motricity index, finger tapping, motor activity log-28, MEP latency, amplitude, resting motor threshold (rMT), central motor conduction time (CMCT) and functional magnetic resonans imaging were used for assessment and follow-up. The patients were randomized to two groups (real rTMS, sham rTMS) and rTMS was applied for five consecutive days (1 Hz, %90 rMT, 20 minute). Motor and functional status were negatively correlated with MEP latency, rMT, CMCT, and were positively correlated with MEP amplitude, and spasticity was negatively correlated with MEP amplitude at baseline evaluation. There were better clinical and electrophysiological improvements in rTMS group and it was statistically better than sham group in regard to Brunnstrom upper extremity stage. There was significant decrease in spasticity in real rTMS group. rMT for spasticity and CMCT for motor improvement were found as hopeful parameters for prognosis determination. In conclusion, TMS evoked electrophysiological parameters had significant correlation with clinical status and improvement, and they were suggestive parameters for prognosis determination and follow-up. Additionally, it was considered that rTMS applications will continue to attract the attentions as a novel therapeutic approach for stroke rehabilitation. stroke, motor evoked potential, transcranial magnetic stimulation, neurorehabilitation