A Comparative Study of Motor Recovery from Stroke between High and Low Frequency Electrical Acupoint Stimulation

서 론

,

functional magnetic resonance imaging (fMRI)

2007 9 5 2007 9 6

2007 9 17

: , ,

1 2

( ) 130-702

(Tel : 02-958-9129, Fax : 02-958-9132, E-mail : [email protected])

김영석, 홍진우, 정우상, 나병조, 박성욱, 문상관, 박정미, 고창남, 조기호, 배형섭

원 저

A Comparative Study of Motor Recovery from Stroke between High and Low Frequency Electrical Acupoint Stimulation

Young-suk Kim, Jin-woo Hong, Woo-sang Jung, Byung-jo Na, Seong-uk Park, Sang-kwan Moon, Jung-mi Park, Chang-nam Ko,

Ki-ho Cho, Hyung-sup Bae

Department of Cardiovascular & Neurologic Diseases (Stroke Center), College of Oriental Medicine, Kyung Hee University, Seoul, Korea

Objectives : Electrical acupoint stimulation (EAS) has been used to treat motor dysfunction of stroke patients with reportedly effective results. The purpose of this study was to evaluate the efficacy of EAS with different frequencies in treating motor dysfunction of ischemic stroke patients.

Methods : The subjects of this study were sixty-two ischemic stroke patients with motor dysfunction at Kyunghee Oriental Medicine Hospital who were hospitalized for one week to one month from onset. They were treated with 2Hz or 120Hz EAS for two weeks, and motor evoked potentials (MEP) were measured before and after EAS treatment. To compare the effect of 2Hz EAS with 120Hz, we measured latency, central motor conduction time (CMCT) and amplitude of MEP before and after EAS treatment.

Results : After two weeks of treatment, we compared MEP data of the affected side between the 2Hz group and the 120Hz group. The 2Hz group showed more significant improvement than the 120Hz group in latency, CMCT and amplitude (P=0.008, 0.002, 0.002). In case of the affected side MEP data divided by normal side MEP data, the 2Hz group also showed improvement on latency, CMCT and amplitude with significant differences (P=0.003, 0.000, 0.008).

Conclusions : These results suggest that low frequency EAS activates the central motor conduction system better than high frequency EAS, and it means that EAS with low frequency is more helpful for motor recovery after ischemic stroke than that with high frequency.

Key Words

Motor area

1)

.

. ,

2)

, Positron Emission Tomography(PET) fMRI, Single Photon Emission Computed Tomography(SPECT)

3-5)

.

.

(Motor Evoked Potential, MEP) (transcranial magnetic sti- mulation, TMS)

. scale

,

.

.

(2Hz) (120Hz)

, MEP

National Institute of health stroke scale (NIHSS), Modified Barthel Index(MBI), Modified motor assessment scale(MMAS)

6)

.

,

.

연구방법

1.

연구대상 1)

2006 12 2007 8

2

1 1

MEP .

,

MEP (

, , , X ,

) .

2)

.

MEP

, ,

Vital sign

,

3)

.

, 3

MEP

4)

2Hz 120Hz

.

2.

치료방법 MEP

, 1 stainless-steel

( 0.25mm, 4cm, ,

Korea) (GFP-91, Siemui Co,

Japan) . 3mA

, 5:4 15 , 1 , 1

6 , 2 ,

10 20mm

. MEP

(LI4), (LI11), (LI11),

(TE5) ,

(ST36), (ST37), (GB39),

(LV3) . 2

, ( , ),

,

.

3.

측정 및 검사방법

1)

( , ),

8

. JNC (Joint National

Commitee On Prevention, Detection, Evaluation and Treatment of High Blood Pressure)

1 (Stage 1 hypertension) ,

(American Diabetes Association) 126mg/dL

.

ASPECTS(Albert Stroke Program Early CT

Score) . ASPECTS MCA territory

2 axial slices 10 1 .

2) (Motor Evoked Potential.

MEP)

2 TMS

. Magnetic

stimulation(Magstim model 200, Medelec , UK) (Mistral, Medelec , UK)

. ,

. coil

7cm, 2cm

,

(Abductor

pollicis brevis, APB) .

APB

APB

. APB

C5-7 coil ,

. Latency(

), CMCT(Central motor conduction time, ), Amplitude( ) 3

. Latency

APB milli-second

, CMCT Latency

Latency .

3)

2

NIHSS, MBI, MMAS

. , MEP

,

.

4.

데이터 분석 및 통계처리

1) MEP improvement presence

Latency, CMCT, Amplitude 3 MEP

. Potential

, 3

.

score of affected side :

.

score of affected side devided by score of normal side :

, (ratio)

.

Magnetic stimulation Potential

MEP . 2)

2Hz 120Hz

2 NIHSS, MBI, MMAS

. MEP APB

, upper limb

MMAS .

3)

SPSS(Statistical Program for Social Science) 12.0 for Window

. 2Hz 120Hz baseline

characteristics 2

Chi-square test or Fisher's

exact test Student

t-test . P-value

0.05 .

연구결과

1.

대상 환자들의 일반적 특징

116 2 MEP

62

. 54

3 , 7 ,

5 , MEP 2

, 37 .

62 2Hz 32 18 (56.3%),

120Hz 30 13 (48%) ,

2Hz 64.9±9.8 , 120Hz

64.5±10.6

.

2Hz 14.9±7.2 , 120Hz 15.7±8.6

. NIHSS, MBI, MMAS

.

,

ASPECTS

(Table 1).

2.

전침치료 전후의

측정값 비교

1) Change of MEP improvement presence : score of affected side

2 MEP

Characteristic 2Hz Group

(N=32)

120Hz Group

(N=30) P*

Female sex, n(%) 18(56.3) 13(43.3) 0.309

Age, year(SD) 64.9(9.8) 64.5(10.6) 0.516

Time since stroke, day(SD) 14.9(7.2) 15.7(8.6) 0.260

Medical history

Hypertension, n(%) 19(59.4) 19(63.3) 0.749

Diabetes Mellitus, n(%) 11(34.4) 9(30.0) 0.713

FBS(mg/dL)(SD) 113.9(31.0) 108.5(29.1) 0.766

LDL-c(mg/dL)(SD) 119.7(39.2) 107.0(32.5) 0.109

NIH Stroke Scale(SD) 6.8(4.0) 8.0(3.7) 0.931

Modified Barthel Index(SD) 48.8(30.7) 44.4(31.4) 0.884

Modified Motor Assessment Scale(SD) 17.3(12.8) 12.4(11.4) 0.281

ASPECTS(SD) 2.7(2.9) 3.1(2.3) 0.578

*: Chi-square test for gender, medical history and Infarction lesion. Student t-test for the Others.

SD: standard deviation FBS: fasting blood sugar

LDL-c: low density lipoprotein cholesterol ASPECTS: Albert Stroke Program Early CT Score

Items Group(n) after 2 weeks

n(%) P*

Latency 2Hz(32) 14(43.8)

0.008

120Hz(30) 4(13.3)

CMCT 2Hz(32) 16(50.0)

0.002

120Hz(30) 4(13.3)

Amplitude 2Hz(32) 11(34.4)

0.002

120Hz(30) 1(3.3)

*: Fisher's exact test for Amplitude, Chi-square test for the others.

MEPs: Motor evoked potentials, CMCT: central motor conduction time

Latency, CMCT,

Amplitude 3 3

2Hz 120Hz

(Table 2).

2) Change of MEP improvement presence : Ratio (score of affected side devided by score of normal side)

2Hz 32 120Hz 30

2 MEP

Latency, CMCT,

Amplitude Latency, CMCT,

Amplitude 2Hz 120Hz

. (Table 3).

3.

전침치료 전후의

의 측정 값 비교

2Hz 32 120Hz 30

2 NIHSS, MBI, MMAS,

MMAS(upper limb) 2Hz

(Table 4).

Items Group(n) after 2 weeks

n(%) P*

Latency 2Hz(32) 14(43.8)

0.003

120Hz(30) 3(10.0)

CMCT 2Hz(32) 15(46.9)

0.000

120Hz(30) 2(6.7)

Amplitude 2Hz(32) 9(28.1)

0.008

120Hz(30) 1(3.3)

*: Fisher's exact test for Amplitude, Chi-square test for the others.

MEPs: Motor evoked potentials, CMCT: central motor conduction time

Items Group(n) baseline after 2weeks

Δ P*

Mean Mean

NIHSS 2Hz(32) 6.8±4.0 5.0±4.0 1.84±1.55

0.372

120Hz(30) 8.0±3.7 6.5±3.7 1.50±1.46

MBI 2Hz(32) 48.8±30.7 64.9±31.7 16.16±15.09

0.091 120Hz(30) 44.4±31.4 54.7±31.9 10.27±11.5

MMAS 2Hz(32) 17.3±12.8 24.0±14.4 6.66±6.23

0.295 120Hz(30) 12.4±11.4 17.5±13.4 5.13±5.00

MMAS (upper limb)

2Hz(32) 4.2±5.6 6.4±7.0 2.22±2.95

0.116

120Hz(30) 1.5±3.7 2.7±4.7 1.20±1.94

*: Student t-test.

NIHSS: NIH stroke scale, MBI: Modified Barthel Index, MMAS: Modified motor assessment scale, EAS: electrical acupoint stimulation

고 찰

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1825 Sarlandiere

.

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,

.

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15)

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, Neu- rotransmitters Neuropeptides

17-20)

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21)

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(2Hz) (80Hz)

ovarian blood flow ,

ovarian sympathetic nerve

22)

.

fMRI

1)

.

2Hz 100Hz

, 2Hz

Primary motor area, Supplementary motor area Superior temporal gyrus

, 100Hz

Brodmann area 40(supram- arginal gyrus) Caudal anterior cingulate cortex, Nucleus accumbens Pons

. 100Hz

2Hz

Motor area .

,

.

(TMS, transcranial magnetic stimulation) MEP

23,24)

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25-27)

. MEP

. Stroke

, Dominkus CMCT

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, Kandler

CMCT Amplitude

Amplitude

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central motor conduction system . MEP

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, NIH stroke scale(NIHSS), Modified Barthel Index(MBI), Modified motor

assessment scale(MMAS) 2Hz

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MEP

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감사의 말씀

2007

(KHU-2007-080).

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