임상 경두개 도플러 검사

김종순,류재관,Kim, Jong-Soon,Ryoo, Jae-Kwan 대한물리치료과학회 1999 대한물리치료과학회지 Vol.6 No.4

The transcranial Doppler(TCD) is a technique for measuring blood flow velocity of intracranial and extarcranial arteries. This examination based on Doppler effect which was first formulated in 1842 by the Austrian physicist Christian Doppler. In 1982, Rune Aaslid first maked 2MHz pulsed probe and recording intracranial vessels with transcranially. There are six criteria utilized in gaining positive identification of the intracranial vessels. The six criteria are as follows l)acoustical windows 2)depth of sample volume 3)direction of flow 4)spatial relationship of ACA and MCA bifurcation 5)mean velocity and 6)response common carotid artery compression and/or oscillation test. The affected factors for TCD examination are angle of insonation, posture of subject, age, gender, hematocrit, metabolic factors, and cardiac output. Clinical application of TCD are detection of stenosis, occlusion, emboli, thrombsis in intracranial and extracranial arteries and evaluation of cerebral arterovenous malformation, collateral capacity in the circle of Willis, ischemia cerebrovascular disease, stroke patient and vertebrobasilar system.

심장 판막 수술 후 미세색전의 변화

조수진,이은일,백만종,오삼세,나찬영 대한흉부외과학회 2003 Journal of Chest Surgery (J Chest Surg) Vol.36 No.5

배경: 경두개 초음파 검사에 의한 미세색전의 진단은 향후 뇌색전증의 위험이 높은 환자의 선별에 큰 도움이 되리라 기대된다. 우리는 전향적으로 심장 판막 수술 전과 후의 미세색전의 양성률과 빈도를 검사하였다. 대상 및 방법: 심장 판막 질환이 있는 50명의 환자를 대상으로 본 연구는 진행되었다. 뇌경색의 병력이 있거나, 과거에 인공 기계 심장 판막 수술을 받은 환자는 본 연구에서 제외하였다. 경두개 초음파 검사는 중대뇌동맥에서 1시간 동안 미세색전을 감시하였고, 수술 전과 수술 후 2차례 검사하였다. 결과: 기계 심장 판막 수술은 28명, 조직 판막 수술은 10명, 승모판막 성형술은 12명에서 시행되었다. 미세색전의 양성률은 수술 전(8%)에 비하여 수술 후(50%)에 의미 있게 증가하였으며(p=0.00), 미세색전은 항응고제 강도, 심장 부정맥, 환자의 연령, 고혈압의 병력과 관련성이 없었다. 기계 심장 판막 이식수술 후 미세색전의 양성률(71.4%)은 조직 판막 이식수술(10%)이나 승모판막 성형술(33.3%)에 비하여 의미 있게 높았다(p=0.002). 결론: 미세색전은 심장 판막 수술 후 의미 있게 증가하며 이러한 변화는 인공 기계 심장 판막 수술 후 색전증의 위험과 관련되어 있다고 추정된다.

고빈도 반복 경두개 자기자극의 임상 적용 및 효과에 관한 고찰

정중우,박신규,정재훈 한국자기학회 2024 韓國磁氣學會誌 Vol.34 No.1

Transcranial magnetic stimulation (TMS) is a representative non-invasive method of stimulating the cerebral cortex. In this study, we sought to investigate the clinical application and effects of high frequency repetitive transcranial magnetic stimulation (HF-rTMS). To date, various protocols for repetitive transcranial magnetic stimulation (rTMS) have been introduced in clinical practice, including low frequency repetitive transcranial magnetic stimulation (LF-rTMS) and HF-rTMS are popularly used. HF-rTMS is a method of increasing activity by stimulating the cerebral cortex on the damaged side, while LF-rTMS is applied to the cerebral cortex on the nondamaged side. The two protocols each have their own advantages and disadvantages, and HF-rTMS has been reported to be more effective than LF-rTMS by stimulating the cerebral cortex on the damaged side. However, problems are being raised due to various side effects such as headaches due to stronger stimulation compared to LF-rTMS. Through previous studies, HF-rTMS has reported positive results for various diseases such as major depressive disorder, stroke, dementia, mild cognitive impairment, and Parkinson's disease, and has shown effects on exercise and cognition. 경두개 자기자극(transcranial magnetic stimulation, TMS)은 대뇌 겉질을 자극하는 대표적인 비침습적인 방법이다. 본 연구에서는고빈도 반복 경두개 자기자극(high frequency repetitive transcranial magnetic stimulation, HF-rTMS)의 임상적용 및 효과에 대해 알아보고자 하였다. 현재까지 임상에서는 다양한 반반복 경두개 자기자극(repetitive transcranial magnetic stimulation, rTMS)의 프로토콜이 소개되고 있으며, 그 중 저빈도 반복 경두개 자기자극(low frequency repetitive transcranial magnetic stimulation, LF-rTMS)과 HFrTMS가대중적으로 사용되고 있다. HF-rTMS는 손상측 대뇌 겉질에 자극하여 활성도를 증가하는 방법이며, LF-rTMS는 비손상측대뇌 겉질에 적용하는 방법이다. 두 가지의 프로토콜은 각각 장점과 단점이 있으며, HF-rTMS는 손상측 대뇌 겉질에 자극을 줌으로써 LF-rTMS보다 더 큰 효과성을 보고하고 있다. 그러나 LF-rTMS에 비해 강한 자극으로 인해 두통 등 다양한 부작용으로 인해문제점이 제기되고 있다. 선행 연구를 통해 HF-rTMS는 주요우울장애, 뇌졸중, 치매, 경도인지장애, 파킨슨병 등 다양한 질환에대한 긍정적인 결과를 보고하였으며, 각각 운동, 인지 등의 효과를 나타내었다.

경두개촬영 및 Polytome-U 촬영에서의 하악과두위 비교

나경수,조봉혜 大韓口腔顎顔面 放射線學會 1998 Imaging Science in Dentistry Vol.28 No.2

The authors examined the condylar position and shape of condylar process from the transcranial radiographs and polytomographs of the 130 temporomandibular joints of 65 patients who complained symptoms of temporomandibular disorder and the followings were obtained; 1. The age and sex distribution of 65 patients showed peak incidence in 2nd decade (27.7%) followed by 3rd (18.5%) and 4th decade (18.5%) and female predominance (87.7%) 2. In polytomography 64 joints (49.2%) showed consistent condylar position from lateral to medial and 39 joints (30.0%) of them showed agreement with those of transcranial radiographs. Among the 66 joints (50.8%) which showed changes in condylar position, 48 joints (36.9%) showed agreement with lateral and central tomographic and transcranial radiographic position. 41 joints (31.5%) showed disagreement in condylar position between the polytomographic and transcranial radiographic images. 3. When the condylar position was classified as anterior, central and posterior, the posterior position was the most frequent position, that is, 42.3% of the transcranial radiography and 42.3%, 49.2% and 38.5% of the lateral, central and medial polytomographic radiographs. 4. In polytomography 84 joints (64.6%) showed consistent condylar shape from lateral to medial and 74 joints (56.9%) of them showed agreement with those of transcranial radiographs. Among the 46 joints (35.4%) which showed changes in condylar shape, 40 joints (30.1%) showed agreement with lateral and central tomographic and transcranial radiographic shape. 41 joints (31.5%) showed disagreement in condylar shape between the polytomographic and transcranial radiographic images.

Onsite-effects of dual-hemisphere <i>versus</i> conventional single-hemisphere transcranial direct current stimulation : <i>A functional MRI study</i>

Kwon, Yong Hyun,Jang, Sung Ho Medknow PublicationsMedia Pvt Ltd 2012 Neural regeneration research Vol.7 No.24

<P>We performed functional MRI examinations in six right-handed healthy subjects. During functional MRI scanning, transcranial direct current stimulation was delivered with the anode over the right primary sensorimotor cortex and the cathode over the left primary sensorimotor cortex using dual-hemispheric transcranial direct current stimulation. This was compared to a cathode over the left supraorbital area using conventional single-hemispheric transcranial direct current stimulation. Voxel counts and blood oxygenation level-dependent signal intensities in the right primary sensorimotor cortex regions were estimated and compared between the two transcranial direct current stimulation conditions. Our results showed that dual-hemispheric transcranial direct current stimulation induced greater cortical activities than single-hemispheric transcranial direct current stimulation. These findings suggest that dual-hemispheric transcranial direct current stimulation may provide more effective cortical stimulation than single-hemispheric transcranial direct current stimulation.</P>

골도 청력검사에서 이간감약의 임상적평가

이재석,홍석민,김성균,김희진,홍석진,박일석,김용복,심민경,금보람 한국청각언어재활학회 2016 Audiology and Speech Research Vol.12 No.4

Purpose: It is commonly known that there is no significant transcranial attenuation across the cranium through bone conduction. The aim of this study was to evaluate transcranial attenuation for bone conduction as a function of each frequency by hearing loss types on subjects of unilateral hearing loss or unilateral with bilateral hearing loss. Methods: A total of 82 subjects with sensorineural (40 ears), conductive (20 ears) and mixed hearing loss (22 ears), were enrolled and then were analyzed prospectively. The transcranial attenuation was analyzed for 82 ears with the differences over 10 dB HL in all frequencies (0.25-4 kHz) by air conduction audiometry. The transcranial attenuation at each frequency was obtained by bone conduction threshold without masking. Results: We observed a significant in the mean of transcranial attenuation for bone conduction of the overall subjects. It was closed to 0-9 dB HL at 0.25 kHz to 2 kHz and 13 dB HL at 3 to 4 kHz. There are more difference in principal the transcranial attenuation for bone conduction in high frequency than a low frequency. Conclusion: Therefore, the conductive and mixed hearing loss always need to consider about the masking by crosshearing. The cross-hearing, however, needs to consider by type of hearing loss because the transcranial attenuation of bone conduction as a function of each frequency depends on hearing loss types. Further research should work for the transcranial attenuation of bone conduction by degrees of hearing loss.

교합안정장치 사용 전, 후의 하악과두 위치 변화에 관한 연구

이숙경,윤영주,김광원 대한치과교정학회 1998 대한치과교정학회지 Vol.28 No.1

본 연구는 조선대학교 부속 치과병원 교정과에 내원하여 교정치료를 시행하고 있는 환자중 panadent 교합기 및 condylar position indicator(CPI)를 이용하여 중심위-중심교합 편위양을 측정한 결과, 전후방 및 수직적 편위양이 1.00mm이내, 측방편위양이 0.30mm이내인 정상범주를 넘는 부정교합 환자 47명을 대상으로 하여 3개월간 교합안정장치를 24시간 장착하고, CPI 및 transcranial projection을 이용하여 교합안정장치 장착전과 장착후의 하악과두의 위치변화를 관찰한 결과 다음과 같은 결론을 얻었다. 1. CPI상의 모든 군에서 중심교합-중심위 사이에 통계적인 유의성이 있었다(P<0.001). 2. transcranial projection 상의 superior joint space의 Rt와 Lt+Rt/2에서 중심교합-중심위 사이에 통계적인 유의성이 있었다(P<0.05). 3. CPI상의 모든 superior-inferior components군에서 교합안정장치 사용 전, 후의 중심교합-중심위 사이에 통계적인 유의성이 있었다(P<0.01). 4. transcranial projection상의 superior joint space의 Rt를 제외한 모든 군에서 교합안정장치 사용 전, 후의 중심교합-중심위 사이에 통계적인 유의성이 없었다. 이상의 결론을 종합해 볼 때 중심교합-중심위 사이의 변화를 평가하는 데는 transcranial projection보다 CPI가 보다 유용하며, 교합안정장치는 하악과두의 전, 후방적 위치변화보다는 수직적 위치변화에 미치는 영향이 보다 큰 것으로 보인다. Stabilization splint therapy precedes orthodontic intervention to enable the operator to find a "true" centric(which is stable and comfortable); to test the patient's response to a change in the occlusion, prior to embarking upon a complex course of occlusal therapy; and finally, to see if the centric relation position can be stabilized. For this study, 47 malocclusion patients enrolled for orthodontic treatment at the Department of Orthodontics, College of Dentistry, Chosun University comprised the malocclusion group, little variation of growth factor by the second molar eruption. They had Cr-Co discrepancy beyond normal range. For each patients the stabilization splint with mutually protected type of occlusal scheme was applied for 3 months. Condylar position in CR and CO were measured using Panadent articulators, Panadent condylar position indicator(CPI), and transcranial projection before & after stabilization splint therapy. On the base of this study, the results of this study were as follows: 1. In all samples using CPI, there were statistical significances in CR-CO discrepancy(P<0.001) both before & after stabilization splint therapy. 2. In Rt and Lt+ Rt/2 of superior joint space using transcranial projection, there were statistical significances in CR-CO discrepancy({<0.05) before & after stabilization splint therapy. 3. In supero-inferior components using CPI, there were statistical significances in CR-CO discrepancy(P<0.01) before & after stabilization splint therapy. 4. In all components except Rt using transcranial projection, there were no statistical significances in CR-CO discrepancy(P>0.05) before & after stabilization splint therapy. To sum up, CPI might be more effective than transcranial projection to reveal the changes between CR-CO discrepancies and stabilization splint might be more useful appliance for displaying the vertical changes, than the antero-posterior changes, of condylar position.

경두개방사선사진과 자기공명영상을 이용한 측두하악관절 골변화에 관한 연구

조수범,고광준,Cho Su-Beom,Koh Kwang-Joon 대한영상치의학회 2002 Imaging Science in Dentistry Vol.32 No.2

Purpose: To evaluate the diagnostic accuracy of transcranial radiographs and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) in the assessment of osseous changes of the condylar head and articular eminence. Materials and Methods: Osseous changes of the TMJ were evaluated in forty-three patients. Osseous changes of the condylar head and articular eminence were observed in 41 joints and 64 joints, respectively on transcranial radiographs, and 48 joints and 59 joints, respectively on MRI. Results: The flattening, sclerosis, erosion, and osteophyte formation of the condylar heads were observed in 36.6%, 43.9%, 12.2%, and 7.3%, respectively on transcranial radiographs compared with 35.4%, 20.8%, 37.5%, and 6.3%, respectively on MRI. While, the flattening, sclerosis, and erosion of the articular eminences were observed in 26.6%, 67.2%, and 6.2%, respectively on transcranial radiographs compared with 32.2%, 59.3%, and 8.5%, respectively on MRI. Conclusion: There were no statistical differences between transcranial radiographs and MRI scans in the detection of osseous changes of the TMJ. However, MRI scans were superior to the transcranial radiographs in the detection of erosion of the condylar head (p<0.01).

우울증에서 비침습적 두뇌 자극 치료

채정호(Jeong-Ho Chae) 대한신경정신의학회 2018 신경정신의학 Vol.57 No.2

Despite the fact that pharmacotherapy depressive disorders have proven efficacy, a substantial number of patients are resistant to conventional management. As neuroscientific research about pathophysiology of depression have accumulated, repeated transcranial magnetic stimulation(rTMS) and transcranial direct current stimulation (tDCS) have emerged as an important mechanism-based treatment modality. This overview provides a review of therapeutic application of rTMS and tDCS in patients with depression. The clinical and basic studies of rTMS and tDCS in depression were reviewed and integrated using a literature review and interview with experts. rTMS is a noninvasive procedure of a localized pulsed magnetic field to the surface of the head to cause a depolarization of neurons in the brain cortex. tDCS has a mechanism of modulating cortical excitability in a polarity-specific manner without eliciting action potentials. rTMS and tDCS seem promising for treating depression. Although therapeutic parameters and further technical improvement remain to be systematically investigated, rTMS and tDCS would be a safe and effective intervention to treat depression.

뇌졸중 환자의 상지기능 향상을 위한 경두개 직류 자극과 강제 유도 운동 치료의 결합 중재 효과에 대한 체계적 고찰

김선호 대한신경계작업치료학회 2019 재활치료과학 Vol.8 No.4

Objective : This systematic review aimed to investigate the impact of transcranial direct current stimulation combined with constraint-induced movement therapy (CIMT) in patients with stroke Methods : PubMed and NDSL databases were employed to review literature published between January 2009 and December 2018. The main search terms were “Transcranial direct current stimulation” or “tDCS,” “Constraint-induced movement therapy” or “CIMT,” “Upper extremity function,” “Upper limb,” and “Stroke.” Based on the inclusion and exclusion criteria, 6 articles were selected. Furthermore, intervention effects on upper extremity function, activities of daily living, and cortical activity were assessed. Results : The current intensity, application time, and protocol of the CIMT varied the between studies. However, the intervention procedures to perform CIMT immediately after transcranial direct current stimulation was the same. Transcranial direct current stimulation combined with CIMT was effective in improving upper limb function and activities of daily living in patients with stoke and had a significant effect on cerebral cortex activation. Conclusions : This study provides information on transcranial direct current stimulation combined with CIMT for use by clinical therapists. Further studies are needed to standardize the stimulation time, current intensity, and electrode attachment position. Furthermore, randomized controlled trials, including long-term follow up, are needed for larger populations using the most appropriate CIMT protocol. 목적 : 경두개 직류 자극과 강제 유도 운동 치료의 결합된 중재를 적용한 뇌졸중 환자의 회복과 관련된연구 동향을 알아보고, 중재 계획 시, 도움이 될 수 있는 정보 및 근거를 제시하는 데 목적이 있다. 연구방법 : 전자 데이터베이스 PubMed, NDSL 등을 이용하여 2009년 1월부터 2018년 12월까지 10년간온라인 데이터에 등록된 논문을 검색하였다. 주요 검색어로 ‘Transcranial direct current stimulation’ or ‘tDCS’, ‘Constraint-induced movement therapy’ or ‘CIMT’, ‘Upper extremity function’, ‘Upper limb’, ‘Stroke’을 혼용하여 사용하여 본 연구의 선정기준과 배제기준에 부합하는 6편의 논문을 최종선정하여 분석하였다. 결과 : 경두개 직류 자극의 적용 전류의 세기, 적용시간 등과 강제 유도 운동 치료의 프로토콜은 다양한방법으로 이루어져 있었지만, 경두개 직류 자극 직 후 CIMT를 시행하는 중재 절차는 동일하게 시행되었다. 중재 효과를 알아보기 위해 상지기능, 일상생활동작, 대뇌피질 활성도 평가 등이 사용되었다. 경두개직류 자극과 강제 유도 운동 치료의 결합된 중재는 뇌졸중 환자의 상지기능과 일상생활동작 개선에효과적인 것으로 나타났으며, 대뇌피질의 활성화에도 유의미한 효과가 있는 것으로 나타났다. 결론 : 본 연구를 통해 경두개 직류 자극과 강제 유도 운동 치료의 결합된 중재 적용에 필요한 정보 제공및 근거를 마련하였다. 추후 연구를 통해, 경두개 직류 자극의 자극시간과 전류의 세기, 전극의 부착위치 등에 대한 일반화가 필요할 것이며 가장 적절한 강제 유도 운동 치료 프로토콜을 사용하여 큰모집단을 대상으로 장기간 추적 관찰을 포함한 무작위 대조군 실험연구가 필요하다.