CN106075731A - Based on the dyskinetic method of transcranial magnetic stimulation treatment post-stroke - Google Patents
Based on the dyskinetic method of transcranial magnetic stimulation treatment post-stroke Download PDFInfo
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- A61N2/00—Magnetotherapy
- A61N2/004—Magnetotherapy specially adapted for a specific therapy
- A61N2/006—Magnetotherapy specially adapted for a specific therapy for magnetic stimulation of nerve tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
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- A61N2/02—Magnetotherapy using magnetic fields produced by coils, including single turn loops or electromagnets
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Abstract
The present invention is open a kind of based on the dyskinetic method of transcranial magnetic stimulation treatment post-stroke, including: the transcranial magnetic stimulation positioning cap being made up of cerebral lobe, the distribution of brain motor area, EEG electrode alignment system is positioned, determines stimulation location;By at least two stimulating coil, with parameter preset, described stimulation location is stimulated.The present invention makes the transcranial magnetic stimulation technology of twin coil to combine Neural stem cell positioning cap treatment post-stroke dyskinetic location stimulation therapy simple to operation, and low price, effect are notable;Selection in conjunction with treatment parameters such as stimulus frequency, stimulus intensity, stimulation time, intermittent time, treatment times, it is achieved the purpose of the two-ways regulation brain function of transcranial magnetic stimulation.
Description
Technical field
The present invention relates to transcranial magnetic stimulation technical field, particularly relate to a kind of based on transcranial magnetic stimulation treatment post-stroke fortune
The method of dynamic obstacle.
Background technology
Apoplexy (stroke), also referred to as apoplexy or cerebrovas-cularaccident, be due to brain inside blood vessel rupture suddenly
Hemorrhage or because blood vessel blockage causes cerebrum ischemia, anoxia to cause.Clinical manifestation is with burst disturbance of consciousness or facial hemiparalysis, half body
Unsuccessful, inarticulateness, cognitive disorder are principal character.China's prevalence rate of stroke is up to about 0.6%, and number of patients is up to
500-600 ten thousand, annual new cases about 1,500,000, annual died nearly 1,000,000, in survivor, about 1/4 loses labor to some extent
Power, severe disabled person accounts for 40%.
Apoplexy sequela is the topmost sequela of apoplexy, and currently used method of rehabilitation and treatment means have: fortune
Dynamic therapy, occupational therapy, naturopathy (such as functional electric stimulation, biofeedback therapy and corresponding physical therapy) and rehabilitation engineering
(suitable orthopedic brace can be configured for hemiplegic limb, to stop limbs to deform, miscellaneous function activity).Exercise therapy, work
Industry therapy, rehabilitation engineering are required for patient's certain motor function of remaining and need the partner treatment that patient is positive, treatment week
Phase is long;FES may cause stimulation location pain, the danger of skin burn secondary infection, at present, Ren Menyue
Carry out the most importances recognizing rehabilitation, it is desirable to by one safely, effectively, without adverse affects naturopathy side
Method reaches the purpose of rehabilitation.Physical therapy modalities development space is very big, but naturopathy means, instrument present on market
The curative effect such as device, equipment differs, transcranial magnetic stimulation be a kind of noinvasive, painless, safely, the effective physics that is not directly contacted with human body controls
Treatment method.Utilizing electromagnetic induction principle, discharged to stimulating coil by electrical switch by the high-voltage capacitance of energy storage, stimulating coil produces
The magnetic field of raw transition, through skull, at the cortex induction faradic current that brain table is shallow, stimulates intracranial neural, causes neuron membrane
The change of current potential, excitatoty change and regulate function of nervous system.
Transcranial magnetic stimulation technology passes through specific stimulus frequency, stimulus intensity, stimulation time, intermittent time, changes big
The irritability of Cerebral cortex, promotes the recovery of function of nervous system, and current transcranial magnetic stimulation single coil stimulates one position of head, controls
Therapeutic effect is not ideal enough.And in transcranial magnetic stimulation uses, because scalp and the covering of skull, it is difficult to according to disease not
The same stimulation point finding intracranial optimal, the most simply stimulates absorbed position according to operator's eye estimate single coil, positions
Stimulate and affected by artificial technology/experience and deviation occurs;More advanced method is the transcranial magnetic stimulation skill of MRI image navigation
Art, but navigator is expensive, and operation complexity is time-consuming, be difficult to Clinical practice and popularization.
Summary of the invention
In order to overcome the deficiencies in the prior art, the present invention proposes a kind of based on transcranial magnetic stimulation treatment post-stroke motion barrier
The method hindered, makes the transcranial magnetic stimulation technology of twin coil combine the Neural stem cell positioning cap treatment dyskinetic location of post-stroke
Stimulation therapy is simple to operation, and low price, effect are notable, it is achieved the mesh of the two-ways regulation brain function of transcranial magnetic stimulation
's.
In order to achieve the above object, the present invention proposes a kind of based on the dyskinetic side of transcranial magnetic stimulation treatment post-stroke
Method, comprises the following steps:
The transcranial magnetic stimulation positioning cap being made up of cerebral lobe, the distribution of brain motor area, EEG electrode alignment system is entered
Row location, determines stimulation location;
By at least two stimulating coil, with parameter preset, described stimulation location is stimulated.
Preferably, described by by cerebral lobe, brain motor area distribution, EEG electrode alignment system form through cranium magnetic sting
Sharp positioning cap positions, and determines that the step of stimulation location includes:
After bilateral earhole and pillow, tuberosity is for 3 wearing positions determining positioning cap of labelling, finds the motor cortex of correspondence
M1 district, determines stimulation location.
Preferably, described by least two stimulating coil, the step described stimulation location stimulated with parameter preset
Suddenly include:
Utilize two magnetic stimulation coils, stimulate the strong side of brain and the stimulation location of Ipsilateral with parameter preset simultaneously, tool
Body includes:
Using high frequency stimulation Ipsilateral precentral gyrus M1 district, low frequency stimulating is good for precentral gyrus M1 district, side, described parameter preset bag
Include: stimulus frequency, stimulus intensity, stimulation time, intermittent time and treatment time parameter.
Preferably, described stimulus intensity (%): RMT* (0.8-0.9);Low frequency stimulating frequency: 0.5~1Hz;High frequency stimulation
Frequency: 10~20Hz;Stimulation time: 2-10S (second);Intermittent time: 2-5S;Treatment time: 20-30m (minute).
Preferably, described by least two stimulating coil, the step described stimulation location stimulated with parameter preset
Suddenly include:
First coil stimulates the wrist median nerve position of affected limb, the second coil to stimulate Ipsilateral precentral gyrus M1 district;
The couple stimulation of composition twin coil, first coil first stimulates, and behind interval 20~25ms, the second coil stimulates, stimulus intensity (%):
RMT*(0.8-0.9);Stimulus frequency: 0.1Hz;Treatment time: 30m.
Preferably, described method also includes:
Stimulating coil magnetic field intensity point of maximum intensity is placed on optimal stimulus position stimulate with 45 ° of direction tangential.
Preferably, treatment cycle is: 6-8 week.
The one that the present invention proposes is based on the dyskinetic method of transcranial magnetic stimulation treatment post-stroke, by cerebral lobe, brain fortune
The distribution of dynamic functional areas, the transcranial magnetic stimulation positioning cap of EEG electrode alignment system composition, it is achieved accurately determining of transcranial magnetic stimulation
Position, makes the transcranial magnetic stimulation technology of twin coil control combining the treatment post-stroke dyskinetic location stimulation of Neural stem cell positioning cap
Treating simple to operation, low price, effect are notable;By stimulus frequency, stimulus intensity, stimulation time, intermittent time, treatment
The selection of the treatment such as time parameter, it is achieved the purpose of the two-ways regulation brain function of transcranial magnetic stimulation.
Compared to existing technology, the present invention program has the advantage that
1, method realizes low cost, and treatment cycle is short, reduces the medical expense of patient;
2, easy to operate, time saving and energy saving, improve the work efficiency of medical personnel;
3, associating transcranial magnetic stimulation positioning cap makes stimulation location more accurate, it is achieved that repeats continued stimulus accurately, carries
The high function modulation stimulating nerve and therapeutic effect;
4, provide the new method of the dyskinetic rehabilitation of post-stroke, reduce the disability rate of apoplexy.
Accompanying drawing explanation
Fig. 1 is that in the embodiment of the present invention, the stimulating coil of chronic phase treatment stimulates schematic diagram;
Fig. 2 is that the stimulating coil of acute stages treated in the embodiment of the present invention stimulates schematic diagram.
In order to make technical scheme clearer, clear, it is described in further detail below in conjunction with accompanying drawing.
Detailed description of the invention
Should be appreciated that specific embodiment described herein, only in order to explain the present invention, is not intended to limit the present invention.
First, introduce the transcranial magnetic stimulation positioning cap of the embodiment of the present invention, including: with the housing of human brain external shape fits, institute
State be correspondingly provided with on housing for two cerebral hemispheres of labelling, four cerebral lobes, EEG electrode position, motor cortical function district with
And the labeling section of tuberosity after the earhole of location of attaching the names of pre-determined candidates, pillow.
Wherein, two Interhemispheric labeling section of described labelling are for distinguishing the Interhemispheric center line in both sides.
Described four cerebral lobes are respectively frontal lobe, top, temporal lobe and occipital lobe.
Labeling section corresponding to described EEG electrode position includes sagittal line before and after labelling left and right brain hemisphere, from left ear
Front point is by the transverse presentation line before central point to auris dextra, and side bit line.
Each labeling section is arranged on the housing in the way of silk-screen layer.
Transcranial magnetic stimulation positioning cap of the present invention is cerebral cortex sophisticated functions structure to be done several on head surface project
Point, based on conventional EEG electrode location 10-20 system or 10-10 system, cerebral lobe, EEG electrode position, earhole
With the position of tuberosity after pillow as mark silk-screen to having on resilient medicated cap, when being branded as, it is directed at tuberosity after bilateral earhole and pillow
Labelling 3 can make a three-dimensional surface, as the benchmark of band cap.
Specific implementation is as follows:
Transcranial magnetic stimulation positioning cap of the present invention, according to the distribution of brain function district and brain anatomy body surface projection, marks differentiation
The Interhemispheric center line in both sides, indicates 4 cerebral lobes of frontal lobe, top, temporal lobe, occipital lobe, identifies with blue line, facilitates medical personnel's root
Distinguish and the standard location of electroencephalogram (10-20) (10-10) system according to the visualization of positioning cap, find optimal thorn the most accurately
Swash position.
Utilize international electroencephalogram 10-the standard electric that the most international electroencephalogram association of 20 (10-10) system electrode placement methods specifies
Pole placement methods makes telltale mark point, and odd number represents left side, and even number represents right side.Stimulate cap according to EEG electrode and brain skin
Matter leaflet and ditch return between anatomy relationship, positioning cap calibrates the position of bilateral cerebral cortex motor area because
The location of motor region is that Neural stem cell causes the target most basic stimulation point of flesh action.
Transcranial magnetic stimulation first has to the determination threshold stimulus of individuation, and motor cortex thumb position to be found accurately is short to draw thumb
The minimum stimulation intensity that diductor muscle moves, as threshold stimulus intensity, determines stimulus intensity with the percentage ratio of threshold intensity, so
The cortical motor areas rapidly finding out thumb is the basis implementing transcranial magnetic stimulation technology.
In clinical indication, a lot of diseases all cause dyskinesia, such as the apoplexy dyskinesia, spinal cord injury, handkerchief
The gloomy diseases of gold etc., cerebral cortex motorium is sensorimotor highest maincenter, is positioned at 4th district and 6 of cerebral cortex precentral gyrus
District, identifies sensorimotor regulation feature, transcranial magnetic stimulation positioning cap according to anatomical location and the motor area of cerebral cortex
Somatic movement maincenter, including Head And Face, finger, trunk, extremity, the activity of side motor cortex domination opposite side body muscle;
The target flesh of specific cortex hormone function region domination offside, uses and stimulates cap to have the Orientation of functions that help is fine.
This technology reflects 2 cerebral hemispheres of people, 4 cerebral lobes, conventional EEG electrode position, motions on positioning cap
Cortex hormone function district and attach the names of pre-determined candidates location earhole, pillow after tuberosity labelling point, information contained is many, it is simple to operates, be easy to repeatedly treat
Accurately can stimulate in the repetition at same position.
The low cost that this technology realizes, reduces the medical expense of patient;Easy to operate, time saving and energy saving, improve equipment
Utilization rate.Multiple location label information in positioning cap makes stimulation location more accurate, it is simple to determining of stimulation location during scientific research
Position describes and repetitive stimulation.Solve tradition and stimulate the uncertainty of location by range estimation and experience, can improve and stimulate neural merit
Can modulation and therapeutic effect.
Transcranial magnetic stimulation positioning cap of the present invention compares traditional auxiliary locator, has the advantage that
1, simple in construction, easy to make, reduce equipment cost and the medical treatment cost of patient, navigation need not be used, increase volume
Outer medical expense.
2, easy to operate, time saving and energy saving, improve the work efficiency of medical personnel to greatest extent.
3, divide brain function district, the anchor point of each functional areas, in conjunction with the feature of disease, instruct medical personnel to pinpoint
Stimulate.
4, accelerate the development of transcranial magnetic stimulation technology, promote the popularization at home of transcranial magnetic stimulation technology, more more
Wide field is that the mankind service.
5, stimulation location is accurate, and specific aim is higher, reaches optimal therapeutic effect in the shortest time, decreases trouble simultaneously
The treatment cycle of person and medical expense.
Additionally, the one that also proposes of the present invention is based on the dyskinetic method of transcranial magnetic stimulation treatment post-stroke, including
Following steps:
S1, the transcranial magnetic stimulation positioning cap being made up of cerebral lobe, the distribution of brain motor area, EEG electrode alignment system
Position, determine stimulation location;
S2, by least two stimulating coil, stimulates described stimulation location with parameter preset.
First, determine, according to the testing result of iconography or the hemiplegic limb of patient, the motor cortex side that patient is impaired;
After bilateral earhole and pillow, tuberosity is for 3 wearing positions determining positioning cap of labelling, finds the motor cortex of correspondence
M1 district, determines stimulation location;
According to clinical treatment prescription, stimulus frequency, stimulus intensity, stimulation time, intermittent time, treatment time ginseng are set
Number;
Stimulating coil magnetic field intensity point of maximum intensity is placed on optimal stimulus position and carries out effective stimulus with 45 ° of direction tangential.
Fix coil brace, stationary positioned cap, it is ensured that therapeutic process moderate stimulation coil not shift position, it is ensured that most preferably control
Therapeutic effect.
Specifically, the motor cortex of Normal brain has and suppresses function alternately, the post-stroke dyskinesia, Ipsilateral motor cortex
Because hypoxic-ischemic is impaired, strong lateral movement cortex still has inhibitory action to Ipsilateral brain, Ipsilateral brain can not to the suppression of strong side brain,
Promoting strong side brain irritability to strengthen, the suppression to Ipsilateral brain also strengthens, and is unfavorable for the rehabilitation of Ipsilateral brain.
The present embodiment specifically uses following scheme:
Scheme one, it is adaptable to the treatment of chronic phase.See Fig. 1:
The present invention utilizes 2 magnetic stimulation coils, stimulates strong side and the Ipsilateral of brain simultaneously, improves and stimulates curative effect.
High frequency stimulation Ipsilateral precentral gyrus M1 district, improves the irritability of Ipsilateral motor cortex;
Low frequency stimulating is good for precentral gyrus M1 district, side, reduces the irritability of strong lateral movement cortex, reduces strong side and presses down Ipsilateral
Make and use.
Stimulus intensity (%): RMT* (0.8-0.9);
Low frequency stimulating frequency (Hz): 0.5~1;
High frequency stimulation frequency (Hz): 10~20;
Stimulation time (S): 2-10;
Intermittent time (S): 2-5;
Treatment time (m): 20-30;
Secondary/week: 5;
Treatment cycle: 6-8.
Scheme two: be applicable to acute stages treated.See Fig. 2:
It is applied to the principle that association is stimulated, with the stimulus frequency of intrasonic 0.1Hz, stimulates Ipsilateral brain safer, more
Easily tolerance, directly facilitates damaged part nerve rehabilitation.
First coil stimulates the wrist median nerve position of affected limb;
Second coil stimulates Ipsilateral precentral gyrus M1 district;
The couple stimulation of composition twin coil, first coil first stimulates, and behind interval 20~25ms, the second coil stimulates.Wherein:
Stimulus intensity (%): RMT* (0.8-0.9);
Stimulus frequency (Hz): 0.1Hz;
Treatment time (m): 30;
Secondary/week: 5;
Treatment cycle: 6-8.
Compared to existing technology, there is advantages that
1, noinvasive, operation painless, easy, repeatable, be not required to directly contact human body, by mobile stimulating coil, can stimulate not
With the nerve at position, including nervus centralis and peripheral nervous.
2, in conjunction with the transcranial magnetic stimulation location being made up of cerebral lobe, the distribution of brain motor area, EEG electrode alignment system
Cap can realize being accurately positioned substantially, reaches optimal therapeutic effect, solves the difficult problem that transcranial magnetic stimulation location is difficult.
3, stimulate at head with twin coil simultaneously, the chronic convalescent period for the treatment of apoplexy, treatment cycle is short, better efficacy.
4, stimulate head and peripheral nervous respectively with intrasonic twin coil, meet Temporal dependency regulation neural plasticity,
Reduce the stimulation risk of suffering from acute stroke, more safely and effectively.
5, improve with positioning cap and stimulate precision, easy to operate, time saving and energy saving, improve the work of medical personnel to greatest extent
Make efficiency.
6, it is provided that the new method of the dyskinetic rehabilitation of post-stroke, reduce the disability rate of apoplexy.
7, stimulus frequency, stimulus intensity, stimulation time, intermittent time, the selection for the treatment of time treatment parameter, it is achieved through cranium
The purpose of the two-ways regulation brain function of Neural stem cell.
Above are only the preferred embodiments of the present invention, not thereby limit the scope of the claims of the present invention, every utilize this
Equivalent structure or flow process that bright description and accompanying drawing content are made convert, or are directly or indirectly used in other relevant technology neck
Territory, is the most in like manner included in the scope of patent protection of the present invention.
Claims (7)
1. one kind based on the dyskinetic method of transcranial magnetic stimulation treatment post-stroke, it is characterised in that comprise the following steps:
It is fixed to be carried out by the transcranial magnetic stimulation positioning cap being made up of cerebral lobe, the distribution of brain motor area, EEG electrode alignment system
Position, determines stimulation location;
By at least two stimulating coil, with parameter preset, described stimulation location is stimulated.
Method the most according to claim 1, it is characterised in that described will by cerebral lobe, brain motor area distribution, electroencephalogram
The transcranial magnetic stimulation positioning cap of positioning of electrode system composition positions, and determines that the step of stimulation location includes:
After bilateral earhole and pillow, tuberosity is for 3 wearing positions determining positioning cap of labelling, finds the motor cortex M1 district of correspondence,
Determine stimulation location.
Method the most according to claim 1, it is characterised in that described by least two stimulating coil, with parameter preset
The step stimulating described stimulation location includes:
Utilize two magnetic stimulation coils, stimulate the strong side of brain and the stimulation location of Ipsilateral with parameter preset simultaneously, specifically wrap
Include:
Using high frequency stimulation Ipsilateral precentral gyrus M1 district, low frequency stimulating is good for precentral gyrus M1 district, side, and described parameter preset includes: thorn
Swash frequency, stimulus intensity, stimulation time, intermittent time and treatment time parameter.
Method the most according to claim 3, it is characterised in that described stimulus intensity (%): RMT* (0.8-0.9);Low frequency
Stimulus frequency: 0.5~1Hz;High frequency stimulation frequency: 10~20Hz;Stimulation time: 2-10S;Intermittent time: 2-5S;During treatment
Between: 20-30m.
Method the most according to claim 1, it is characterised in that described by least two stimulating coil, with parameter preset
The step stimulating described stimulation location includes:
First coil stimulates the wrist median nerve position of affected limb, the second coil to stimulate Ipsilateral precentral gyrus M1 district;Composition
The couple stimulation of twin coil, first coil first stimulates, and behind interval 20~25ms, the second coil stimulates, stimulus intensity (%): RMT*
(0.8-0.9);Stimulus frequency: 0.1Hz;Treatment time: 30m.
6. according to the method according to any one of claim 1-5, it is characterised in that described method also includes:
Stimulating coil magnetic field intensity point of maximum intensity is placed on optimal stimulus position stimulate with 45 ° of direction tangential.
7. according to the method according to any one of claim 1-5, it is characterised in that treatment cycle is: 6-8 week.
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CN107007936A (en) * | 2017-05-22 | 2017-08-04 | 威海市立医院 | New transcranial magnetic stimulation positioner |
CN107616794A (en) * | 2017-09-26 | 2018-01-23 | 北京师范大学 | A kind of disturbance of consciousness cerebral cortex condition detecting system and method |
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CN110650776A (en) * | 2017-04-03 | 2020-01-03 | 阿尔托大学理工学院 | Control of transcranial magnetic stimulation |
CN110650776B (en) * | 2017-04-03 | 2023-12-26 | 阿尔托大学理工学院 | Transcranial magnetic stimulation control |
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CN109481845A (en) * | 2018-12-28 | 2019-03-19 | 深圳先进技术研究院 | A kind of method and relevant apparatus of the transcranial magnetic stimulation acting on Different brain region |
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CN110420389A (en) * | 2019-08-12 | 2019-11-08 | 四川大学华西医院 | A kind of the visual cortex localization method and device of transcranial magnetic stimulation |
CN110975153A (en) * | 2019-12-06 | 2020-04-10 | 中国科学院苏州生物医学工程技术研究所 | Configuration method and system for deep brain stimulation, electronic device and storage medium |
CN110975153B (en) * | 2019-12-06 | 2023-09-08 | 中国科学院苏州生物医学工程技术研究所 | Deep brain stimulation configuration method and system, electronic equipment and storage medium |
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CN115120873B (en) * | 2022-08-30 | 2023-05-09 | 首都医科大学宣武医院 | Helmet type closed loop rhythmicity regulator |
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Application publication date: 20161109 |