Effects of coupling inhibitory and facilitatory repetitive transcranial magnetic stimulation on motor recovery in patients following acute cerebral infarction

Abstract

BACKGROUND: The treatment for patients suffering from motor dysfunction following stroke using continuous repetitive transcranial magnetic stimulation (rTMS) has the potential to be beneficial for recovery. However, the impact of explicit results on the coupling of various rTMS protocols on motor treatment in patients following acute cerebral infarction remain unexplored. OBJECTIVE: The current study aims to design a sham-controlled randomized report to explore the capability of consecutive suppressive-facilitatory rTMS method to increase the motor results following acute stroke. METHODS: A hundred ischemic stroke patients suffering from motor disorder were randomly assigned to obtain 4 week sessions of (1)10 Hz over the ipsilesional primary motor cortex (M1) and next 1 Hz over the contralesional M1; (2) contralesional sham stimulation and next ipsilesional real 10 Hz; (3) contralesional real 1 Hz rTMS and next ipsilesional sham stimulation; or (4) bilateral sham-control procedures. At 24 hours before and after the intervention, we obtained cortical excitability data from study subjects. At baseline, after treatment and 3 months follow up, we additionally evaluated patients with the clinical assessments. RESULTS: At post-intervention, group A showed greater motor improvements in FMA, FMA-UL, NIHSS, ADL and mRS values than group B, group C and group D, that were continued for at least 3 months after the completion of the treatment time. Specifically, it is shown in the cortical excitability study that the motor-evoked potential (MEP) amplitude and resting motor threshold (rMT) more significantly improved in group A than other groups. The improvement in motor function and change in motor cortex excitability exhibit a significant correlation in the affected hemisphere. The combined 1 Hz and 10 Hz stimulation treatment showed a synergistic effect. CONCLUSIONS: Facilitatory rTMS and coupling inhibitory produced extra satisfactory results in facilitating the motor’s recovery in the subacute and acute phase following stroke compared to that acquired from alone single-course modulation.

Repetitive Transcranial Magnetic Stimulation Improves Neuropathy and Oxidative Stress Levels in Rats with Experimental Cerebral Infarction through the Nrf2 Signaling Pathway

“…rTMS has been found to promote the recovery of exercise, learning, and memory in patients with cerebral infarction and to improve neurological damage in rats with cerebral ischemia and reperfusion [ 26 , 27 ]. In our experiments, it was found that in rats treated with rTMS, the neurological deficit scores were reduced, and the time to remove bilateral stickers and the time to cross the balance beam was reduced, which confirmed that rTMS can improve the neuromotor function of rats with experimental cerebral infarction.…”

Magnetic Resonance Imaging Image Segmentation Under Artificial Intelligence Neural Network for Evaluation of the Effect of Butyphthalide Combined With Edaravone on Neurological Function in Patients With Acute Cerebral Infarction

“…Compared with that before treatment, the number of patients with severe cerebral infarction or even vascular stenosis was significantly reduced ( P < 0.05), with a gradual shift to mild vascular stenosis and a marked improvement in neurological dysfunction. It was consistent with the findings of Chen et al ( 2021 ). It was verified that the MRI image segmentation technology based on CNN algorithm can perform accurate segmentation of acute cerebral infarction lesions and improve the MRI image diagnosis effect of acute cerebral infarction.…”

Effects of repetitive transcranial magnetic stimulation on upper-limb and finger function in stroke patients: A systematic review and meta-analysis of randomized controlled trials

“…Seventeen studies were divided into five subgroups based on the number of treatment sessions: 5 sessions, 10 sessions, 12-15 sessions, and 20 sessions. The effect sizes were as follows: (SMD, 0.35; 95% CI 0.09-0.62; P = 0.009) for 5 sessions (20,22,23); (SMD, 0.50; 95% CI −0.00-1.01; P = 0.052) for 10 sessions (38,46,49,51,52); (SMD, 1.39; 95% CI −0.98-3.75; P = 0.25) for 12-15 sessions (30,50) and (SMD, 3.73; 95% CI 1.22-6.24; P = 0.004, Supplementary Figure 2D) for 20 sessions (32).…”

“…Sub-studies were identified in sixteen studies. These studies included 2 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), 3 (32)(33)(34) and 4 experimental groups (35) (each group differed in terms of patient characteristics or TMS protocol) and indicated the FMA-UE scores respectively, for each subgroup separately. The mean age of patients varied from 51.0 to 74.0 years, and the mean age of controls ranged from 50.5 to 75.0 years.…”

“…The post-intervention outcome is represented here by the timing of the assessment rounds: short-term, intermediate, and long-term effects. Fourteen studies (20,26,30,49,(51)(52)(53)59, 61, 63, 64) had short-term follow-up within 0-1 month after the end of the intervention, 23 studies (20,22,23,28,31,32,35,38,44,50,51,57,61,63,64) had intermediate follow-up assessments lasting 2-5 months after the end of intervention, and 3 studies (50, 51, 61) had long-term assessments. A significant benefit was found at short-term follow-up (SMD, 0.27; 95% CI 0.04-0.51; P = 0.023) and medium-term follow-up (SMD, 1.23; 95% CI, 0.74-1.73; P = 0), whereas no significant effect was observed at long-term follow-up (SMD, 1.61; 95% CI −0.43-3.65; P = 0.121) (Supplementary Figure 5 and Table 2).…”