DOI QR코드

DOI QR Code

Effect of the application of low-frequency rTMS on cognitive function in chronic stroke patients

저빈도 rTMS의 적용이 만성 뇌졸중환자의 인지기능에 미치는 영향

  • Lee, Dong-Woo (Department of Physical Therapy, Honam University)
  • 이동우 (호남대학교 물리치료학과)
  • Received : 2014.11.21
  • Accepted : 2014.12.11
  • Published : 2014.12.31

Abstract

This study repeated low-frequency transcranial magnetic stimulation (rTMS) to evaluate the effects on cognitive function in chronic stroke patients. Among the chronic stroke patients, 30 patients selected by MMSE-K and BCRS-K were divided randomly into 3 groups. Group I (n=10) had only sound applied, group II (n=10) were applied 1 Hz rTMS on the damaged side and group III (n=10) were applied to 1 Hz rTMS on the opposite side for total 2 weeks, 20 minutes per a day, five times per a week. To examine the change in cognitive function, CREAD-K scores were measured before, 1 week, 2 weeks, and then 3 months after the intervention. The CREAD-K scores were measured before and 1 week, 2 weeks and 3 months after the interventions. The immediate recall memory showed a significant difference after 2 weeks and 3 months in groups II and III (p<.05), The recognition memory showed a significant difference after 2 weeks and 3 months in group III (p<.05). The delayed recall memory showed significant differences after 3 months in group III than in group I (p<.05). Therefore, the application of low-frequency rTMS has a positive influence on the cognitive rehabilitation of chronic stroke patients.

본 연구는 저빈도 반복경두개자기자극(rTMS)이 만성 뇌졸중 환자의 인지기능에 미치는 영향을 알아보기 위해 실시하였다. MMSE-K와 한국어판 BCRS-K를 통해서 선별된 만성 뇌졸중 환자 30명을 대상으로 3개의 군으로 무작위로 나누었다. 실험군 I(n=10)은 소리만 동일시간 적용하게 하였고, 실험군 II(n=10)은 손상 측에 1 Hz rTMS를, 실험군 III(n=10)은 손상반대측에 1 Hz rTMS를 적용하여 주 5회, 1일 20분, 2주간 중재하였다. 인지기능의 변화를 알아보기 위해서 중재 전, 1주 후, 2주 후, 3개월 후 시점에서 CERAD-K 점수를 측정하였다. 연구 결과 즉각 기억단어는 실험군 I에 비교하여 실험군 II와 실험군 III에서 2주 후와 3개월 후에 통계학적으로 유의한 차이를 보였고(p<.05), 재인 기억단어에서는 실험군 III에서 2주 후와 3개월 후에 통계학적으로 유의한 차이가 나타났다(p<.05). 지연 기억단어는 실험군 I에 비해 실험군 III에서 3개월 후에 통계학적으로 유의한 차이를 보였다(p<.05). 따라서 본 연구결과를 통해서 뇌졸중 환자에서 저빈도 rTMS의 적용이 인지재활에 긍정적인 영향을 줄 수 있을 것으로 생각된다.

Keywords

References

  1. Statistics Korea. Annual report on the causes of death statistics, 2012.
  2. Sabari, J. S. "Motor Control, Motor recovery after stroke", In: Deusen JV & Brunt D. Assessment in Occupational Therapy and Physical therapy. W. B. Saunders Company, USA, pp. 249-271, 1997.
  3. Narasimhalu, K., Ang S., De Silva, D. A., Wong, M. C., Chang, H. M., Chia, K. S., Auchus A. P., & Chen, C. P. "The prognostic effects of poststroke cognitive impairment no dementia and domain-specific cognitive impairments in nondisabled ischemic stroke patients", Stroke, 42(4), pp. 883-888, 2011. DOI: http://dx.doi.org/10.1161/STROKEAHA.110.594671
  4. Martin, M. W. "Cognition", 3rd ed, New York: Harcourt Brace Publishers, 1995.
  5. Wheately, C. J. "Evaluation and treatment of cognitive dysfunction", Occupational therapy practice skills of physical dysfunction. Mosby, pp. 241-252, 1995.
  6. Seong Ran Lee. "A study on relationship between activities of daily living and cognitive score in stroke patients", Master thesis, Daegu University, 2003.
  7. Trombly, C. A. "Occupational Therapy for Dysfunctions", 3rd ed. Baltimore, William & Wilkins, 1989.
  8. Fang, Y., Chen, X., Li, H., Lin, J., Huang, R., & Zeng J. "A study on additional early physiotherapy after stroke and factors affecting functional recovery", Clin Rehabil, 17(6), pp. 608-617, 2003. DOI: http://dx.doi.org/10.1191/0269215503cr655oa
  9. Sisson, R. A. "Cognitive status as a predictor of right hemisphere stroke outcomes", J Neurosci Nurs, 27(3), pp. 152-156, 1995. DOI: http://dx.doi.org/10.1097/01376517-199506000-00003
  10. Waldowski, K, Seniow, J, Bilik, M, & Czlonkowska, A. "Transcranial magnetic stimulation in the therapy of selected post-stroke cognitive deficits: aphasia and visuospatial hemineglect", Neurol Neurochir Pol, 43(5), pp. 460-469, 2009.
  11. Webster, B. R., Celnik, P. A., & Cohen, L. G. "Noninvasive brain stimulation in stroke rehabilitation", NeuroRx, 3(4), pp. 474-481, 2006. DOI: http://dx.doi.org/10.1016/j.nurx.2006.07.008
  12. Jalinous, R. "Technical and practical aspects of magnetic nerve stimulation", Journal of Clinical Neurophysiology, 8(1), pp. 10-25, 1991. DOI: http://dx.doi.org/10.1097/00004691-199101000-00004
  13. Rothwell, J. C., Hallett, M., Berardelli A., Eisen, A., Rossini, P., & Paulus, W. "Magnetic stimulation : motor evoked potentials", The International Federation of Clinical Neuro- physiology. Electroencephalogr Clin Neurophysiol Suppl, 52, pp. 97-103, 1995.
  14. Tassinari, C. A., Cincotta, M., Zaccara, G., & Michelucci, R. "Transcranial magnetic stimulation and epilepsy", Clin Neurophysiol, 114(5), pp. 777-798, 2003. DOI: http://dx.doi.org/10.1016/S1388-2457(03)00004-X
  15. Benedetti, F., Vighetti, S., Ricco, C., Lagna, E., Bergamasco, B., Pinessi L., & Rainero I. "Pain threshold and tolerance in Alzheimer's disease", Pain, 80(1-2), pp. 377-382, 1999. DOI: http://dx.doi.org/10.1016/S0304-3959(98)00228-0
  16. Guse, B., Falkai, P., & Wobrock, T. "Cognitive effects of high-frequency repetitive transcranial magnetic stimulation : a systematic review", J Neural Transm, 117(1), pp. 105-122, 2010. DOI: http://dx.doi.org/10.1007/s00702-009-0333-7
  17. Rektorova, I., Megova, S., Bares, M., & Rektor, I. "Cognitive functioning after repetitive transcranial magnetic stimulation in patients with cerebrovascular disease without dementia: a pilot study of seven patients", J Neurol Sci, 15(229-230), pp. 157-161, 2005. DOI: http://dx.doi.org/10.1016/j.jns.2004.11.021
  18. Siebner, H. R., & Rothwell, J. "Transcranial magnetic stimulation: new insights into representational cortical plasticity", Exp Brain Res, 148(1), pp. 1-16, 2003. DOI: http://dx.doi.org/10.1007/s00221-002-1234-2
  19. Wheaton, L. A., Villagra, F., Hanley, D. F., Macko, R. F., & Forrester, L. W. "Reliability of TMS motor evoked potentials in quadriceps of subjects with chronic hemiparesis after stroke", J Neurol Sci, 276(1-2), pp. 115-117, 2009. DOI: http://dx.doi.org/10.1016/j.jns.2008.09.012
  20. Summers, J. J., Kagerer, F. A., Garry, M. I., Hiraga, C. Y., Loftus, A., & Cauraugh, J. H. "Bilateral and unilateral movement training on upper limb function in chronic stroke patients: A TMS study", J Neurol Sci, 252(1), pp. 76-82, 2007. DOI: http://dx.doi.org/10.1016/j.jns.2006.10.011
  21. Naeser, Margaret. A., Martin, Paula. I., Ho, M., Treglia, Ethan., Kaplan, Elina., Bashir, Shahid., & Pascual-Leone, Alvaro. "Transcranial magnetic stimulation and aphasia rehabilitation", Arch Phys Med Rehabil, 93(1), pp. 26-34, 2012. DOI: http://dx.doi.org/10.1016/j.apmr.2011.04.026
  22. Jin Ho Kim, & Ryun Han Tae. "Rehabilitation Medicine", Koonja publishing company, pp. 389-391, 2003.
  23. Young Chul Kwon, & Jong Han Park. "Korean Version of Mini-Mental State Examination (MMSE-K) part1; development of the test for the elderly", J Korean Neuropsychiatr Assoc, 28(1), pp. 125-135, 1989.
  24. Ji In You. "The validity of the Korean version of brief cognitive rating scale (BCRS)", Master thesis, Inje University, 2010.
  25. George, M. S., Nahas, Z., Kozel, F. A., Li, X., Denslow, S., Yamanaka, K., Mishory, A., Foust, M. J., & Bohning, D. E. Mechanisms and state of the art of transcranial magnetic stimulation. J ECT, 18(4), pp. 170-181, 2002. DOI: http://dx.doi.org/10.1097/00124509-200212000-00002
  26. George, M. S., Nahas, Z., Kozol, F. A., Li, X., Yamanaka, K., Mishory, A., & Bohning, D. E. "Mechanisms and the current state of transcranial magnetic stimulation", CNS Spectr, 8(7), pp. 496-514, 2003. https://doi.org/10.1017/S1092852900018976
  27. Yong Seol Jeong. "Changes in primary motor and sensory cortex excitability by 10 Hz high frequency rTMS", Master thesis, Kyung Hee University.
  28. Pascual-Leone, A., Valls-Sole, J., Wassermann, E. M. & Hallett, M. "Responses to repetitive transcranial magnetic stimulation of the human motor cortex", Brain, 117(4), pp. 847-858, 1994. DOI: http://dx.doi.org/10.1093/brain/117.4.847
  29. Chen, R., Classen, J., Gerloff, C., Celnik, P., Wassermann, E. M., Hallet, M., & Cohen, L. G. "Depression of motor cortex excitability by low-frequency transcranial magnetic stimulation", Neurology, 48(5), pp. 1398-1403, 1997. DOI: http://dx.doi.org/10.1212/WNL.48.5.1398
  30. Mansur, C. G., Fregni, F., Boggio, P. S., Riberto, M, Gallucci-Neto, J., Santos, C. M, Wagner T., Rigonatti, S. P. Marcolin M. A., & Pascual-Leone, A. "A sham stimulation- controlled trial of rTMS of the unaffected hemisphere in stroke patients", Neurology, 64, pp. 1802- 1804, 2005. DOI: http://dx.doi.org/10.1212/01.WNL.0000161839.38079.92
  31. Jong In Woo. "The Korean version of CERAD neuropsychlogical assessment battery", Seoul University publishing department, 2002.
  32. Jung Mo Lee. "Research articles : problems of the conceptual foundations in psychology (1) : the implications of cognitive psychology on the theory of science in psychology", Korean Psychological Association. 13(1), pp. 21-60, 1994.
  33. Jee Wook Choi, Bum Seok Jeong. "Practival review of transcranial magnetic stimulation. J Korean Soc Biol Ther Psychiatry", 11(1), pp. 5-11, 2005.