The Effect of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation Therapy on Serum Brain-Derived Neurotropic Factor Level and Motor Ability in Ischemic Stroke Patients: A Single-Center Study

Abstract

<jats:p>BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is widely used in various neurological cases. rTMS is an effective method of restoration in patients with disability due to central nervous system disorder.&#x0D; AIM: This study aimed to determine the effect of high and low frequency of rTMS on serum brain-derived neurotropic factor (BDNF) levels and motoric abilities in ischemic stroke patients.&#x0D; METHODS: The study design was an experiment with a purposive sampling consecutive on 27 samples with the onset of ischemic stroke 6 months. The study was conducted from February to October 2018; samples were recruited from Neurology Ward of Wahidin Sudirohusodo hospital and its affiliating centers. The serial of rTMS intervention was delivered in “Brain” Clinic center. After fulfilling the inclusion criteria and the initial examination of serum BDNF and motor ability, samples were randomly divided into two groups, intervention group who received standard therapy with rTMS therapy (n = 14) and the control group who only received standard therapy (n = 13). rTMS was given for 2 min frequency of 1 Hertz (Hz) contralesion and 5 Hz ipsilesion every day for 10 days. Assessment of serum BDNF levels and motor skills was conducted on days 1 and 10 of the study. Serum BDNF levels were measured by the monoclonal antibody ELISA technique while motor skills were measured based on the score of the Stroke Rehabilitation Assessment of Movement (STREAM). Serum BDNF values and the STREAM delta score were compared between the two groups of samples.&#x0D; RESULTS: The results showed significant changes only occurred in motor abilities in both groups of samples after 10 days of rTMS therapy with the Wilcoxon test (p &lt; 0.5). The Mann–Whitney U-test showed a more significant change (p &lt; 0.5) in the treatment group than in the control (p = 0.5).&#x0D; CONCLUSION: rTMS has an effect on improving motor ability in ischemic stroke patients. This change in motor abilities is not related to serum BDNF levels in this study.</jats:p>

Biomarkers associated with functional improvement after stroke rehabilitation: a systematic review and meta-analysis of randomized controlled trials

“…For the effect of the rehabilitation on serum biomarkers in stroke patients, the meta-analysis revealed a moderate evidence, when compared to the control group. Furthermore, the concentration of brain-derived neurotrophic factor (BDNF) significantly increased in the treatment group, and this was significantly correlated to the functional improvement after stroke ( 10 , 14 , 15 , 28 , 34 , 36 , 41 , 47 , 48 ) ( Figure 2 ; Table 1 ). Compared to the control group, the low-quality evidence in the treatment group revealed that the concentration of serum noradrenaline (NE) increased ( 27 , 28 , 36 ), while the concentrations of serum endothelin (ET) ( 39 , 44 , 46 ) and glutamate ( 36 , 40 , 42 ) decreased, and these were significantly associated with the functional improvement after stroke ( Supplementary Figures S2–S4 ; Table 1 ).…”

“…The subgroup analysis based on the rehabilitation therapy revealed that there was a significant correlation with non-invasive brain stimulation (NIBS) therapy, but there was no correlation with no-NIBS ( 36 , 48 ) ( Supplementary Figures S7A,B ; Table 1 ). According to the treatment sessions for NIBS (five sessions vs. 10 sessions vs. 18–20 sessions vs. 30+ sessions), it was found that the serum BDNF concentration was significantly correlated with 18–20 sessions ( 10 , 14 , 28 , 47 ) and 30+ sessions ( 10 , 41 ), but this was not associated with five sessions ( 34 ) and 10 sessions ( 10 , 15 ) ( Supplementary Figures S7C ; Table 1 ).…”

Circulating brain-derived neurotrophic factor as a potential biomarker in stroke: a systematic review and meta-analysis

“…After the precise data extraction for the time of sample collection regarding the stroke onset, we grouped the observation into five general groups. (1) Observations which compared baseline measures to the first day of the stroke, baseline vs day one or acute that covered four observations and 202 participants [ 32 , 39 , 59 , 60 ]; (2) Observations comparing the baseline measures to the peripheral level of BDNF within the first week of stroke onset (mostly 3–7 days) baseline vs week one or sub-acute, consisting of 14 observations and 1366 patients [ 32 , 39 , 42 , 44 , 54 , 56 , 59 , 61 – 67 ]; (3) Observations investigating the difference between baseline levels of BDNF and day 30 or above, baseline vs. over one month or chronic , that included 11 observations and 1093 participants [ 16 , 39 , 43 , 54 , 56 , 65 – 69 ]; (4) Comparison of the first day of the stroke to the first week after the onset, Day 1 vs Week 1 consisting three observations and 162 participants [ 32 , 39 , 59 ]; (5) Lastly the seven observations investigating the BDNF pattern, in 855 participants, within the first week of stroke and over the one months of affecting the patients [ 39 , 54 , 56 , 65 – 67 , 70 ].…”