感覚障害と感覚性運動失調を有する陳旧性視床出血患者に対する反復経頭蓋磁気刺激と作業療法を併用したアプローチの効果―～約10年間，右片手動作主体の日常生活が続いた症例が両手動作に至った～

Combining occupational therapy with repetitive transcranial magnetic stimulation for chronic thalamic hemorrhage with sensory disturbance and sensory ataxia: A case study

要旨：感覚障害や感覚性運動失調を伴った患者に対する反復経頭蓋磁気刺激（以下，rTMS）やrTMSと作業療法併用による上肢機能改善に関する報告は少なく，効果も一様でない．今回，発症後約10年間，感覚障害と感覚性運動失調により日常生活で左手の使用が難しい状態が続いた74歳の陳旧性視床出血患者に対して，15日間，低頻度rTMSと併行して作業療法を実施した結果，上肢運動機能と複合感覚，異常感覚に改善を認め，効果が1ヵ月後まで持続した．また機能的近赤外分光法を用いた脳血流動態計測より随意運動中の大脳皮質興奮性に変化がみられた．上肢機能の改善の背景には，rTMSと併用して行った作業療法が有用であったと考える．

　There are few reports describing the beneficial effects of a combination of occupational therapy and repetitive transcranial magnetic stimulation (rTMS) in patients with sensory disturbance and sensory ataxia. Moreover, the results of these studies have been inconclusive.

　The patient was a 74-year-old man with chronic thalamic hemorrhage who had been experiencing difficulty in the use of the left hand for activities of daily living;the patient had also been experiencing sensory disturbance and sensory ataxia for approximately 10 years. The patient received a combination of occupational therapy and low-frequency rTMS for 15 days and showed an improvement in upper extremity motor function and the sensory disturbances. This improvement persisted for a month. Measurement of cerebral blood flow dynamics using functional near-infrared spectroscopy also revealed a change in cortical excitability during voluntary movement. These results indicate that a combination of occupational therapy and rTMS was indispensable for improvement of upper extremity function.