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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Contralesional Cathodal versus Dual Transcranial Direct Current Stimulation for Decreasing Upper Limb Spasticity in Chronic Stroke Individuals: A Clinical and Neurophysiological Study
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Contralesional Cathodal versus Dual Transcranial Direct Current Stimulation for Decreasing Upper Limb Spasticity in Chronic Stroke Individuals: A Clinical and Neurophysiological Study

机译：慢性阴极卒中与经颅经颅直流电刺激对减少上肢痉挛的临床和神经生理学研究

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Background: Different transcranial direct current stimulation (tDCS) paradigms have been implemented to treat poststroke spasticity, but discordant results have been reported. Objective: This study aimed to determine the efficacy and persistence of dual tDCS (anode over affected motor cortex [M1] and cathode over contralateral M1) compared with cathodal tDCS (cathode over contralateral M1) on upper limb (UL) functional, behavioral, and neurophysiological measures in chronic poststroke individuals. Subjects and Methods: Ten subjects with UL spasticity (7 men; mean 62 years; 8 ischemic stroke; years from event: 2.3 years) were enrolled in a cross-over, double-blinded study. Cathodal and dual tDCS, both preceded by 1 week of sham stimulation 1 month before real stimulation, were applied with 3 months interval. Stimulating paradigm was 20 minutes for five consecutive days in each block. Evaluations were performed before (T1), after real or sham treatment (T2), and after 1 (T3), 4 (T4), and 8 weeks (T5). Functional, behavioral, and neurophysiological tests were performed at each time. Results: Both tDCS paradigms decreased spasticity, increased strength, and ameliorated behavioral scales. Cathodal tDCS was superior to dual tDCS in reducing UL distal spasticity immediately after treatment (T2: cathodal > dual: P = .023) and provided a higher and longer lasting reduction at proximal districts (T3: cathodal > dual: P = .042; T4: cathodal > dual: P = .028; T5: cathodal > dual: P = .05). These findings are supported by an H-reflex modulation (overall time effect P > .002). Conclusions: Cathodal tDCS is slightly more effective than dual tDCS in reducing distal UL spasticity in chronic poststroke subjects. A modulation of spinal inhibitory mechanisms, demonstrated by H-reflex modifications, supports this finding.
机译：背景：已采用不同的经颅直流电刺激（tDCS）范式来治疗中风后痉挛，但已报道了不一致的结果。目的：本研究旨在确定双tDCS（受影响的运动皮质[M1]上的阳极和对侧M1上的阴极）与阴极tDCS（对侧M1上的阴极）在上肢（UL）功能，行为和行为上的功效和持久性慢性卒中后个体的神经生理学措施。受试者和方法：十名患有UL痉挛的受试者（7名男性;平均62岁; 8名缺血性中风;距事件发生的年限：2.3年）参加了一项交叉，双盲研究。阴极和双重tDCS均在3个月的间隔内施加，先于假刺激之前1个月进行假刺激1周。在每个区块中，刺激范例是连续5天20分钟。在（T1）之前，真实或假治疗（T2）之后，1（T3），4（T4）和8周（T5）之后进行评估。每次进行功能，行为和神经生理学测试。结果：两种tDCS范例均降低了痉挛，增加了强度并改善了行为量表。阴极tDCS在治疗后立即降低UL远端痉挛方面优于双重tDCS（T2：阴极>双重：P = .023），并在近端区域提供了更高和更长久的减少（T3：阴极>双重：P = .042; T4：阴极＞双重：P ＝ 0.028; T5：阴极＞双重：P ＝ 0.05。这些发现得到了H反射调制的支持（总时间效应P> .002）。结论：阴极tDCS在减轻慢性卒中后受试者的远端UL痉挛方面比双重tDCS稍微有效。 H反射修饰表明，对脊髓抑制机制的调节支持了这一发现。

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