脑卒中是导致成年人残疾的主要原因,目前普遍认为卒中患者应该同时使用多学科的康复手段进行治疗。脑刺激是近些年用于促进卒中后运动功能康复的新技术,包括重复经颅磁刺激(rTMS)、经皮直流电刺激(tDCS)和硬膜外皮层电刺激(ECS)。研究表明,使用rTMS、tDCS都可以增加神经的可塑性变化,促进运卒中后动功能恢复,ECS则对一些保留有完整皮质脊髓束的患者有一定的疗效。本文对不同脑刺激在促进卒中后运动功能康复中应用的安全性、机制及有效性进行了总结和展望。
Stroke is the leading cause of adult disability.At present,the world has reached a consensus that multidisciplinary treatment for stroke rehabilitation is needed.Brain stimulation is a new technology used to promote the motor function recovery after stroke,including repetitive transcranial magnetic stimulation(rTMS),transcranial direct current stimulation(tDCS)and the epidural cortical stimulation(ECS).Several studies indicated that both rTMS and tDCS can enhance neural plasticity and promote functional recovery after stroke,while ECS was effective in patients with a critical mass of spared corticospinal tractfibers.In this paper,we review the evidence for improved motor function in stroke patients treated with rTMS,tDCS,and ECS and discuss the safety and the physiological mechanisms.