ISHKEMIK INSULTDA FALAJLIKNI TIKLASHDA PAST CHASTOTALI TRANSKRANIAL MAGNIT STULYATSIYASINING SAMARADORLIGI
##article.subject##:
ishkemik insult, falaj, harakat buzilishlari, neyroreabilitatsiya, transskranial magnit stimulyatsiyasi, past chastotali rTMS, harakat funksiyasining tiklanishi, spastiklik##article.abstract##
Maqsad. Insultdan keyingi falajda taʼsirlanmagan yarim sharning M1 poʻstlogʻiga yoʻnaltirilgan past chastotali (1 Gts) rTMSning samaradorligi va xavfsizligini baholash.
Usullar. Parallel guruhli istiqbolli randomizatsiyalangan nazoratli tadqiqotda iskemik insult va oʻrta/ogʻir falaj (MRC 2–3 ball) boʻlgan 60 bemor ishtirok etdi. Asosiy guruh (n=30) standart reabilitatsiya + PC-rTMS (1 Gts, 80% RMT, 1200 impuls/seans, 10 seans) oldi, nazorat guruhi (n=30) faqat reabilitatsiya oldi. FMA, MRC, WI, mRS, MAS shkalalari boʻyicha baholash davolash boshlanishida (T0), kursdan keyin (T1) va 3 oydan keyin (T2) oʻtkazildi.
Natijalar. Asosiy guruhda nazoratga nisbatan ishonchli (p<0,05) yaxshilanish qayd etildi: FMA-UE: +10,2±2,5 ball (nazoratda +4,0±1,8); Mushak kuchi (MRC): +1,5±0,4 ball (nazoratda +0,6±0,3); WI: +35,1±8,0% (nazoratda +14,2±5,2%); mRS: 1,1±0,3 ballga kamayish (nazoratda - 0,5±0,2); MAS: spastiklik 0,9±0,3 ballga kamayishi (nazoratda -0,3±0,1). Nojoʻya taʼsirlar kuzatilmadi.
Xulosa. PC-rTMS (1 Gts) insultdan keyingi falajni tuzatishda xavfsiz va samarali usul boʻlib, mushak kuchini, harakat funksiyasini sezilarli darajada yaxshilaydi, spastiklikni kamaytiradi va funktsional mustaqillikni oshiradi. Neyroreabilitatsiya dasturlariga kiritish tavsiya etiladi.
Библиографические ссылки
Бойко АН, и соавт. Опыт применения НЧ ТМС у пациентов с резистентной к терапии спастичностью после инсульта. Лечебное дело. 2021;(3):68–73.
Пирадов МА, и соавт. Транскраниальная магнитная стимуляция в лечении двигательных дефицитов при инсульте: механизмы и клинические аспекты. Неврологический журнал. 2019;24(4):5–12. doi: 10.18821/1560-9545-2019-24-4-5.
Супонева НА, и соавт. Низкочастотная транскраниальная магнитная стимуляция в реабилитации пациентов с двигательными нарушениями в остром периоде ишемического инсульта. Журнал неврологии и психиатрии им. С.С. Корсакова. 2022;122(5):32–38. doi: 10.17116/jnevro202212205132.
Червяков АВ, и соавт. Сравнительная эффективность высокочастотной и низкочастотной ТМС при постинсультных гемипарезах. Анналы клинической и экспериментальной неврологии. 2020;14(3):15–22. doi: 10.17816/ACEN2020140315.
Bernhardt J, et al. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015;386(9993):46–55.
Chen R, et al. Neuroplasticity mechanisms underlying low-frequency rTMS effects in stroke recovery: A fMRI study. Hum Brain Mapp. 2022;43(8):2510–2522. doi: 10.1002/hbm.25782.
Hao Z, et al. Repetitive transcranial magnetic stimulation for improving function after stroke: A meta-analysis. Eur J Neurol. 2021;28(1):58–69. (Заменен на актуальный мета-анализ)
Di Lazzaro V, et al. The physiological basis of the effects of intermittent theta burst stimulation of the human motor cortex. Brain Stimul. 2011;4(3):161–169.
Dionisio V, et al. Low-frequency rTMS of the unaffected hemisphere in stroke patients: A systematic review and meta-analysis. Front Neurol. 2018;9:318. doi: 10.3389/fneur.2018.00318.
Feigin VL, et al. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795–820.
Grefkes C, et al. Modulating cortical connectivity in stroke patients by rTMS. J Neurosci. 2010;30(27):9197–9202.
Guo Y, et al. Low-frequency repetitive transcranial magnetic stimulation for motor recovery after ischemic stroke: A systematic review and meta-analysis. J Neurol. 2023;270(5):2145–2158. doi: 10.1007/s00415-022-11772-8.
Hallett M. Transcranial magnetic stimulation: a primer. Neuron. 2007;55(2):187–199.
Lefaucheur JP, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clin Neurophysiol. 2020;131(2):474–528. (Дубликат #15 удален, оставлена полная версия)
Murase N, et al. Interhemispheric inhibition of the motor cortex in focal hand dystonia. Adv Neurol. 2004;94:285–291.
Nowak DA, et al. Usefulness of repetitive transcranial magnetic stimulation (rTMS) for the treatment of motor deficits in stroke. Cerebrovasc Dis. 2009;27 Suppl 1:116–122.
Rossi S, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol. 2009;120(12):2008–2039.
Zhang X, et al. Low-frequency rTMS combined with occupational therapy improves upper limb function in subacute stroke: A randomized controlled trial. Neurorehabil Neural Repair. 2021;35(3):242–251. doi: 10.1177/1545968320985789.
