近年来,脑卒中发病率逐年上升,以及中风后的相关后遗症,如认知障碍,运动功能障碍,和中风后抑郁,严重影响患者的康复和日常活动。重复经颅磁刺激(rTMS),作为一个保险箱,非侵入性,和有效的新康复方法,在临床实践中得到了广泛的认可。本文综述了rTMS在治疗不同功能损害(认知障碍、运动功能障碍,单方面的空间忽视,抑郁症)近年来中风后,并初步总结了可能的机制。已经发现,确定rTMS在改善中风后功能损害方面的有效性的关键参数包括脉冲数,受刺激的大脑区域,刺激强度和频率,以及持续时间。一般来说,高频刺激用于刺激同侧大脑皮层,而低频刺激是用来抑制对侧大脑皮层的,从而实现两个半球之间的兴奋性平衡。然而,不同功能损害的具体机制和最佳刺激模式尚未得出一致的结论,需要更多的研究来探索和阐明使用rTMS的最佳方法。此外,我们将确定当前研究中的问题和挑战,探索可能的机制,加深对rTMS的理解,提出未来的研究方向,并为更好的临床应用提供有见地的见解。
In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient\'s rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications.