Observation for the effect of rTMS combined with magnetic stimulation at Neiguan (PC6) and Sanyinjiao (SP6) points on limb function after stroke

Abstract

Background: Stroke is the primary cause of adult disability in China, which causes serious personal, family, and social burden. “Central peripheral central” closed-loop rehabilitation theory is proved to be an effective neural rehabilitation model. Based on this theory, repetitive transcranial magnetic stimulation (rTMS) combined with magnetic stimulation of Neiguan (PC6) and Sanyinjiao (SP6) may be an effective treatment for limb dysfunction after stroke. However, the efficacy and mechanism of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb dysfunction after stroke has not been confirmed. Methods/Design: This study is a prospective, randomized, controlled, open trial. We randomly divided 42 subjects, aged 35 to 80 years, diagnosed with ischemic stroke within 1 month, into 2 groups with a ratio of 1:1. On the basis of this medical treatment, patients in the experimental group received 1 Hz rTMS in M1 area on the contralateral side, and 3 Hz rTMS treatment at Neiguan point and Sanyinjiao point on the affected side. The control group was treated with acupuncture (body acupuncture). All patients were treated once a day and followed up for 10 days. The National Institute of Health Stroke Scale score, simplified fulg Meyer, modified Barthel index, and cortical excitability were evaluated on the day of enrollment and the 10th day of treatment respectively. The modified Barthe index was followed up on the 30th day of treatment, and the adverse reactions were recorded at any time. The mechanism of rTMS will be revealed by Barthe index before treatment, on the 10th day of treatment and on the 30th day of follow-up. The results were analyzed by spss19.0 software, and the quantitative indexes were analyzed by t test and rank sum test. χ 2 test was used for non-grade counting, and rank sum test was used for grade counting. All statistical tests were performed with bilateral test. If P value is less than or equal to .05, the difference will be considered statistically significant. Conclusion: The purpose of this study was to determine the effect of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb function after stroke. Through this study, we expect to explore a new scheme for the treatment of poststroke dyskinesia, and prove that compared with rTMS and acupuncture alone, the closed-loop rehabilitation theory based on “center peripheral center” can be more efficient and safe in the treatment of poststroke limb dysfunction. Trial Registration: The trial was registered in China clinical trial registry ( http://www.chictr.org.cn/index.aspx ), ID: ChiCTR1900026890 (October 25, 2019)

Clinical Effects of Acupuncture for Stroke Patients Recovery

“…In contrast, the storage level of energy and metabolites of the brain itself is shallow, which means that the brain is vulnerable to blood flow interference [ 18 ]. Some studies have found that acupuncture for early stroke (12–24 h) can promote the expression of vascular endothelial growth factor (VEGF), which helps to restore oxygen or nutrition supply in the ischemic penumbra [ 19 ]. Acupuncture also provides a beneficial environment for injured tissue, providing a theoretical basis for acupuncture intervention in early stroke [ 20 ].…”

“…Excessive glutamic acid can damage neurons and induce extemporaneous toxicity. It not only affects the infarcted area but also damages the CA1 subfield of the hippocampus [ 19 ]. Chen et al found that EA could decrease glutamate release in hippocampal CA1 subfield and inhibit hyperemia during reperfusion [ 6 ].…”

Exploration on neurobiological mechanisms of the central–peripheral–central closed-loop rehabilitation

“…In addition, tDCS combined with FES gait training improved post-stroke patients' gait regularity better than a FES gait training intervention only (Mitsutake et al, 2021). In the treatment of stroke, some scholars have used our theoretical method (Yu et al, 2020;Yang et al, 2021). There is no best recommendation for CPC therapy.…”