ORIJINAL ARAŞTIRMA
Geleneksel Rehabilitasyona Ek Olarak Repetetif Transkraniyal Manyetik Stimülasyon ile Tedavi Edilen Kronik İnmeli Hastalarda Tedavi Öncesi Üst Ekstremite Motor Bozukluk Düzeyi ile Motor Kazanım Arasındaki İlişki
Relationship Between Baseline Upper Limb Motor Impairment Level and Motor Gain in Chronic Stroke Patients Treated with Repetitive Transcranial Magnetic Stimulation as an Adjunct to Conventional Rehabilitation
Received Date : 24 Jun 2024
Accepted Date : 31 Oct 2024
Available Online : 07 Nov 2024
Nazrin AGHAZADAa, İlker ŞENGÜLa, Ayhan AŞKINa
aİzmir Kâtip Çelebi University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, İzmir, Türkiye
Doi: 10.31609/jpmrs.2024-104521 - Makale Dili: EN
Turkiye Klinikleri Journal of Physical Medicine and Rehabilitation Sciences. 2025;28(1):48-53
ÖZET
Amaç: Düşük frekanslı repetetif transkraniyal manyetik stimülasyon [low
frequency repetitive transcranial magnetic stimulation (LF-rTMS)] ve geleneksel
rehabilitasyon ile birlikte tedavi edilen kronik inmeli hastalarda tedavi öncesi üst
ekstremite motor bozukluk düzeyi ile motor kazanım arasındaki ilişkiyi araştırmak.
Gereç ve Yöntemler: Bu retrospektif çalışmada, 48 kronik inme hastası
başlangıçtaki Fugl-Meyer Üst Ekstremite Motor Bozukluk Ölçeği [Fugl-Meyer
Upper Extremity Motor Impairment Scale (FM-UL)] skorlarına göre ağır (n=16),
ağır-orta (n=15) ve orta-hafif (n=17) olmak üzere 3 alt gruba ayrıldı. Ardından,
gruplar motor kazanım (FM-UL’deki değişim) açısından karşılaştırıldı. Bulgular:
Konvansiyonel rehabilitasyondan hemen önce 10 seans LF-rTMS tedavisi (istirahat
motor eşiğinin %90’ında toplam 12.000 atım) uygulanması, üst ekstremite
motor bozukluğunun ağırdan orta-hafife kadar tüm seviyelerinde istatistiksel olarak
anlamlı motor kazanımla sonuçlandı [medyan motor kazanım (çeyrekler arası
aralık) ağırdan orta-hafif motor bozukluk düzeyine doğru sırasıyla 0,0 (0,0 ila
1,0), p=0,014; 2,0 (1,0 ila 3,75), p=0,002 ve 2,0 (0,0 ila 4,50), p=0,006]. Gruplar
arasında motor kazanım açısından istatistiksel olarak anlamlı fark vardı (p=0,027).
Şiddetli-orta ve orta-hafif gruplardaki medyan motor kazanımlar şiddetli gruptakilerden
istatistiksel anlamlı olarak daha fazlaydı (düzeltilmiş p değerleri <0,05).
Sonuç: Bu çalışmanın sonuçları, geleneksel rehabilitasyonun ardından uygulanan
LF-rTMS’nin, üst ekstremite motor bozukluk düzeyinden bağımsız olarak
kronik inme hastalarında üst ekstremite motor iyileşmesine katkıda bulunabileceğini
göstermektedir. Bununla birlikte, LF-rTMS’nin tek başına klinik olarak
anlamlı bir etkiye sahip olup olmadığı, inme hastalarını başlangıçtaki üst ekstremite
motor bozukluk düzeylerine göre sınıflandıran sağlam randomize kontrollü
çalışmalarla araştırılmalıdır.
Anahtar Kelimeler: Kronik inme; üst ekstremite motor bozukluk düzeyi; düşük frekanslı repetetif transkraniyal manyetik stimülasyon; motor kazanım
ABSTRACT
Objective: To investigate the relationship between baseline upper
limb motor impairment level and motor gain in chronic stroke patients treated
with low frequency repetitive transcranial magnetic stimulation (LF-rTMS) and
conventional rehabilitation. Material and Methods: In this retrospective study,
48 chronic stroke patients were divided into 3 subgroups according to the baseline
Fugl-Meyer Upper Extremity Motor Impairment Scale (FM-UL) scores: severe
(n=16), severe-to-moderate (n=15), and moderate-to-mild (n=17). The
groups were compared for motor gain (change in the FM-UL). Results: The administration
of 10 sessions of LF-rTMS treatment (a total of 12,000 pulses at 90%
of resting motor threshold) immediately prior to conventional rehabilitation resulted
in statistically significant motor gains at all levels of upper limb motor impairment,
from severe to moderate-to-mild [median motor gains (interquartile
range) were 0.0 (0.0 to 1.0), p=0.014; 2.0 (1.0 to 3.75), p=0.002; and 2.0 (0.0 to
4.50), p=0.006, respectively]. There was also a statistically significant difference
in motor gain between the groups (p=0.027). Median motor gains in the severeto-
moderate and moderate-to-mild groups were significantly larger than those in
the severe group (adjusted p-values were <0.05). Conclusion: The results of this
study suggest that LF-rTMS followed by conventional rehabilitation may contribute
to upper limb motor recovery in chronic stroke patients, regardless of the
level of upper limb motor impairment. However, whether the LF-rTMS has a
clinically meaningful effect in isolation should be investigated in robust randomised
controlled trials stratifying subjects according to their baseline level of
upper limb motor impairment.
Keywords: Chronic stroke; upper limb motor impairment level; low frequency repetitive transcranial magnetic stimulation; motor gain
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