經顱磁剌激改善中風後動作恢復與大腦功能性聯結影像學之探討

10.6666/ClinMed.201902_83(2).0016

蔡元淵；蔡泊意

重覆性經顱磁刺激（repetitive transcranial magnetic stimulation, rTMS） ； 動作恢復（motor recovery） ； 靜息狀態功能性磁振造影（resting-state functional magnetic resonance imaging, RS-fMRI） ； 功能性聯結（functional connectivity）

臨床醫學月刊

83卷2期（2019 / 02 / 22）

86 - 91

繁體中文

中風患者腦部梗塞後，其神經纖維密度、大腦半球內與半球間功能性聯結受到影響，造成動作缺失與功能障礙。急性期兩大腦半球間的運動與感覺區功能性聯結會下降，此聯結下降程度可預測未來功能恢復程度。有效的恢復在慢性期，兩大腦半球間的運動與感覺區功能性聯結會趨近梗塞前正常的功能性聯結；患側大腦半球內運動、感覺及其他的功能性聯結網絡會增加，反映大腦功能性網絡有效的整合與重組（integration and reorganization）。而藉由靜息狀態功能性磁振造影檢查，證實經顱磁刺激可改變大腦皮質興奮性。興奮性磁刺激刺激患側主要運動皮質後，患側主要運動皮質與健側主要運動皮質的功能性聯結會增加，其增加程度與運動恢復直接相關；患側主要運動皮質與健側輔助運動區的功能性聯結會增加，和動作計畫、動作執行能力之恢復有關。在梗塞急性期，興奮性高脈衝式（intermittent theta burst）刺激患側主要運動皮質後，患側主要運動皮質與患側輔助運動區、患側中扣帶迴皮質、健側主要運動皮質、健側背端前運動皮質（dorsal premotor cortex）間的功能性聯結會增加。可見經顱磁刺激利用大腦可塑性重組大腦功能性網絡，影響患側大腦半球內與兩大腦半球間的功能性聯結以恢復動作功能。

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