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Fortschr Neurol Psychiatr 2008; 76(6): 354-360
DOI: 10.1055/s-2008-1038197
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Moderne neurophysiologische Therapiestrategien zur Behandlung motorischer Handfunktionsstörungen nach Schlaganfall

Modern Neurophysiological Strategies in the Rehabilitation of Impaired Hand Function Following StrokeD.  A.  Nowak1, 2 , C.  Grefkes3 , G.  R.  Fink1, 2
  • 1Neurologische Klinik und Poliklinik, Klinikum der Universität zu Köln
  • 2Institut für Neurowissenschaften und Biophysik - Medizin, Forschungszentrum Jülich
  • 3Neuromodulation & Neurorehabilitation, Max-Planck-Institut für Neurologische Forschung, Köln
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Publication History

Publication Date:
29 May 2008 (online)

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Zusammenfassung

Mit modernen neurophysiologischen Stimulationstechniken, wie der repetitiven transkraniellen Magnetstimulation und der transkraniellen Gleichstromstimulation, kann die Erregbarkeit der Hirnrinde in Abhängigkeit von den gewählten Stimulationsparametern für mehrere Minuten reduziert (Inhibition) oder erhöht (Fazilitation) werden. Die zielgerichtete Modulation der Erregbarkeit der Hirnrinde kann plastische Änderungen innerhalb des Netzwerkes sensomotorischer Hirnrindenareale induzieren, wodurch auch pathologische Anpassungsprozesse, zum Beispiel infolge eines Schlaganfalls, positiv beeinflusst werden können. Die therapeutische Anwendung transkranieller hirnstimulierender Verfahren gründet sich im Wesentlichen auf die Hypothese der interhemisphärischen Kompetition. Die Arbeit gibt einen Überblick über die Anwendung von repetitiver transkranieller Magnetstimulation und transkranieller Gleichstromstimulation in der Behandlung von Handfunktionsstörungen nach Schlaganfall.

Abstract

Modern neurophysiological brain stimulation techniques, such as transcranial magnetic stimulation and direct current stimulation, are powerful tools to inhibit or facilitate cortical excitability for several minutes after stimulation depending on the stimulation parameters used. Purposeful modulation of cortical excitability may induce plastic changes within the cortical network of sensorimotor areas, and has the power to improve the function of the affected hand after stroke. The therapeutic use of transcranial brain stimulation techniques is based on the concept of interhemispheric competition. Here we give an overview of the use of repetitive transcranial magnetic stimulation and direct current stimulation in the rehabilitation of impaired hand function after stroke.

Schlüsselwörter

Zerebrale Ischämie - repetitive transkranielle Magnetstimulation - kortikale Gleichstromstimulation - Konzept der interhemisphärischen Kompetition

Key words

stroke - repetitive transcranial magnetic stimulation - transcranial direct current stimulation - interhemispheric competition

Literatur

  • 1 Kolominsky-Rabas P L, Weber M, Gefeller O, Neundörfer B, Heuschmann P U. Epidemiology of ischemic stroke subtypes according to the TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study.  Stroke. 2001;  32 2735-2740
    Search in Google Scholar
  • 2 Lai S M, Studenski S, Duncan P W, Perera S. Persisting consequences of stroke measured by the Stroke Impact Scale.  Stroke. 2002;  33 840-1844
    Search in Google Scholar
  • 3 Kwakkel G, Kollen B J, Wagenaar R C. Long-term effects of intensity of upper and lower limb training following stroke: a randomised trial.  J Neurol Neurosurg Psychiatry. 2002;  72 473-479
    Search in Google Scholar
  • 4 Nakayama H, Jorgensen H S, Raaschou H O, Olsen T S. Recovery of upper extremity function in stroke subjects: the Copenhagen Stroke Study.  Arch Phys Med Rehabil. 1994;  75 394-398
    Search in Google Scholar
  • 5 Hummel F C, Cohen L G. Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke?.  Lancet Neurol. 2006;  5 708-712
    Search in Google Scholar
  • 6 Khedr E M, Ahmed M A, Fathy N, Rothwell J C. Therapeutic trial of repetitive transcranial magnetic stimulation after acute ischemic stroke.  Neurology. 2005;  65 466-468
    Search in Google Scholar
  • 7 Takeuchi N, Chuma T, Matsuo Y, Watanabe I, Ikoma K. Repetitive transcranial magnetic stimulation of contralesional primary motor cortex improves hand function after stroke.  Stroke. 2005;  36 2681-2686
    Search in Google Scholar
  • 8 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. 2005;  64 1802-1804
    Search in Google Scholar
  • 9 Kim Y H, You S H, Ko M H, Park J W, Lee K H, Jang S H, Yoo W K, Hallett M. Repetitive transcranial magnetic stimulation-induced corticomotor excitability and associated motor skill acquisition in chronic stroke.  Stroke. 2006;  37 1471-1476
    Search in Google Scholar
  • 10 Fregni F, Boggio P S, Valle A C, Rocha R R, Duarte J, Ferreira M J, Wagner T, Fecteau S, Rigonatti S P, Riberto M, Freedman S D, Pascual-Leone A. A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients.  Stroke. 2006;  37 2115-2122
    Search in Google Scholar
  • 11 Talelli P, Greenwood R J, Rothwell J C. Exploring Theta Burst Stimulation as an intervention to improve motor recovery in chronic stroke.  Clin Neurophysiol. 2007;  118 333-342
    Search in Google Scholar
  • 12 Nowak D A, Grefkes C, Dafotakis M, Küst J, Karbe H, Fink G R. Improving hand function following stroke: Effects of low frequency rTMS over contralesional motor cortex on movement kinematics and movement-related neural activation.  Arch Neurol. 2008;  im Druck
    Search in Google Scholar
  • 13 Dafotakis M, Grefkes C, Karbe H, Fink G R, Nowak D A. Effects of rTMS on grip force control after subcortical stroke.  Exp Neurol. 2008;  im Druck
    Search in Google Scholar
  • 14 Hummel F, Cohen L G. Improvement of motor function with noninvasive cortical stimulation in a patient with chronic stroke.  Neurorehabil Neural Repair. 2005;  19 14-19
    Search in Google Scholar
  • 15 Hummel F, Celnik P, Giraux P, Floel A, Wu W H, Gerloff C, Cohen L G. Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke.  Brain. 2005;  128 490-499
    Search in Google Scholar
  • 16 Fregni F, Boggio P S, Mansur C G, Wagner T, Ferreira M J, Lima M C, Rigonatti S P, Marcolin M A, Freedman S D, Nitsche M A, Pascual-Leone A. Transcranial direct current stimulation of the unaffected hemisphere in stroke patients.  Neuroreport. 2005 Sep 28;  16 (14) 1551-1555
    Search in Google Scholar
  • 17 Hummel F C, Voller B, Celnik P, Floel A, Giraux P, Gerloff C, Cohen L G. Effects of brain polarization on reaction times and pinch force in chronic stroke.  BMC Neurosci. 2006;  7 73
    Search in Google Scholar
  • 18 Boggio P S, Nunes A, Rigonatti S P, Nitsche M A, Pascual-Leone A, Fregni F. Repeated sessions of noninvasive brain DC stimulation is associated with motor function improvement in stroke patients.  Restor Neurol Neurosci. 2007;  25 123-129
    Search in Google Scholar
  • 19 Murase N, Duque J, Mazzocchio R, Cohen L G. Influence of interhemispheric interactions on motor function in chronic stroke.  Ann Neurol. 2004;  55 400-409
    Search in Google Scholar
  • 20 Kinsbourne M. Mechanisms of hemispheric interaction in man. In: Kinsbourne M, Smith WL, eds. Hemispheric disconnection and cerebral function. Springfield, IL: Thomas 1974: 260-285
    Search in Google Scholar
  • 21 Ferbert A, Priori A, Rothwell J C, Day B L, Colebatch J G, Marsden C D. Interhemispheric inhibition of the human motor cortex.  J Physiol. 1992;  453 525-546
    Search in Google Scholar
  • 22 Plewnia C, Lotze M, Gerloff C. Disinhibition of the contralateral motor cortex by low-frequency rTMS.  Neuroreport. 2003;  14 609-612
    Search in Google Scholar
  • 23 Pal P K, Hanajima R, Gunraj C A, Li J Y, Wagle-Shukla A, Morgante F, Chen R. Effect of low-frequency repetitive transcranial magnetic stimulation on interhemispheric inhibition.  J Neurophysiol. 2005;  94 1668-1675
    Search in Google Scholar
  • 24 Kobayashi M, Hutchinson S, Théoret H, Schlaug G, Pascual-Leone A. Repetitive TMS of the motor cortex improves ipsilateral sequential simple finger movements.  Neurology. 2004;  62 91-98
    Search in Google Scholar
  • 25 Kim Y H, Park J W, Ko M H, Jang S H, Lee P K. Facilitative effect of high frequency subthreshold repetitive transcranial magnetic stimulation on complex sequential motor learning in humans.  Neurosci Lett. 2004;  367 181-185
    Search in Google Scholar
  • 26 Boggio P S, Alonso-Alonso M, Mansur C G, Rigonatti S P, Schlaug G, Pascual-Leone A, Fregni F. Hand function improvement with low-frequency repetitive transcranial magnetic stimulation of the unaffected hemisphere in a severe case of stroke.  Am J Phys Med Rehabil. 2006;  85 927-930
    Search in Google Scholar
  • 27 Hesse S, Werner C, Schonhardt E M, Bardeleben A, Jenrich W, Kirker S G. Combined transcranial direct current stimulation and robot-assisted arm training in subacute stroke patients: a pilot study.  Restor Neurol Neurosci. 2007;  25 9-15
    Search in Google Scholar
  • 28 Grefkes C, Nowak D A, Eickhoff S B, Dafotakis M, Küst J, Karbe H, Fink G R. Cortical connectivity after subcortical stroke assessed with functional magnetic resonance imaging.  Ann Neurol. 2008;  63 236-246
    Search in Google Scholar
  • 29 Gerloff C, Bushara K, Sailer A, Wassermann E M, Chen R, Matsuoka T, Waldvogel D, Wittenberg G F, Ishii K, Cohen L G, Hallett M. Multimodal imaging of brain reorganization in motor areas of the contralesional hemisphere of well recovered patients after capsular stroke.  Brain. 2006;  129 791-808
    Search in Google Scholar
  • 30 Ward N S, Brown M M, Thompson A J, Frackowiak R SJ. Neural correlates of outcome after stroke: a cross-sectional fMRI study.  Brain. 2003;  126 1430-1448
    Search in Google Scholar
  • 31 Lotze M, Markert J, Sauseng P, Hoppe J, Plewnia C, Gerloff C. The role of multiple contralesional motor areas for complex hand movements after internal capsular lesion.  J Neurosci. 2006;  26 6096-6102
    Search in Google Scholar
  • 32 Anwander A, Tittgemeyer M, Cramon D Y von, Friederici A D, Knösche T R. Connectivity-Based Parcellation of Broca's Area.  Cerebr Cortex. 2007;  17 816-825
    Search in Google Scholar
  • 33 Bestmann S, Baudewig J, Siebner H R, Rothwell J C, Frahm J. Functional MRI of the immediate impact of transcranial magnetic stimulation on cortical and subcortical motor circuits.  Eur J Neurosci. 2004;  19 1950-1962
    Search in Google Scholar
  • 34 Ameli M, Grefkes C, Wang L, Dafotakis M, Tittgemeyer M, Karbe H, Fink G R, Nowak D A. Differential effects of high-frequency rTMS on movement kinematics and neural activation in subcortical and cortical MCA stroke.  (Abstract) Neurology. 2008;  70 A206
    Search in Google Scholar
  • 35 Siebner H, Rothwell J C. Transcranial magnetic stimulation: new insights into representational cortical plasticity.  Exp Brain Res. 2003;  148 1-16
    Search in Google Scholar
  • 36 Fregni F, Pascual-Leone A. Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS.  Nat Clin Pract Neurol. 2007;  3 383-393
    Search in Google Scholar
  • 37 Talelli P, Rothwell J. Does brain stimulation after stroke have a future?.  Curr Opin Neurol. 2006;  19 543-550
    Search in Google Scholar
  • 38 Zhang W, Linden D J. The other side of the engram: experience-driven changes in neuronal intrinsic excitability.  Nat Rev Neurosci. 2003;  4 885-900
    Search in Google Scholar
  • 39 Poreisz C, Boros K, Antal A, Paulus W. Safety aspects of transcranial direct current stimulation concerning healthy subjects and patients.  Brain Res Bull. 2007;  72 208-114
    Search in Google Scholar
  • 40 Wassermann E M. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5 - 7, 1996.  Electroencephalogr Clin Neurophysiol. 1998;  108 1-16
    Search in Google Scholar

1 Der Begriff Schlaganfall umfasst ätiologisch sowohl die zerebrale Ischämie als auch die intrazerebrale Blutung. Im Folgenden wird der Begriff Schlaganfall stellvertretend für die zerebrale Ischämie verwendet.

Priv-Doz. Dr. Dennis A. Nowak

Neurologische Klinik und Poliklinik, Klinikum der Universität zu Köln

Kerpener Straße 62

50924 Köln

Email: dennis.nowak@uk-koeln.de