基于大脑半球之间多靶区间歇性θ爆发式磁刺激对脑卒中患者上肢功能的影响

doi:10.3969/j.issn.1006-9771.2022.05.002

Abstract

Abstract:

Objective To investigate the effect of intermittent theta burst stimulation (iTBS) of the multi-target cerebral cortex after stroke on functional recovery of the upper limb of the hemiplegic side. Methods From November, 2019 to August, 2020, 40 stroke patients in Gansu Provine Hospital Rehabilitation Center were included and randomly divided into single-target stimulation group (n = 20) and multiple-target stimulation group (n = 20). Both groups underwent basic neurorehabilitation drug therapy and conventional rehabilitation exercises. The single-target stimulation group received repetitive transcranial magnetic stimulation (rTMS) (iTBS mode) only in the primary motor cortex (M1) of the affected side. The multi-target stimulation group received rTMS (iTBS mode) in the cerebellar cortex of the healthy brain and M1 of the affected side, once a day, six days a week, for four weeks. Before and after treatment, the scores of Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT) and modified Barthel Index (MBI), and the latency and amplitude of somatosensory-evoked potentials N20 were compared. Results No serious adverse reaction occurred during treatment. After treatment, the scores of FMA-UE, MBI and ARAT, and the amplitude and latency of N20 improved in both groups (|t| > 3.478, |Z| > 2.243, P < 0.05); and the scores of FMA-UE and ARAT, and the amplitude of N20 were better in the multiple-target stimulation group than in the single-target stimulation group (t > 2.939, Z = -2.697, P < 0.01). Conclusion Multi-target stimulation is superior to single-target stimulation for improving upper limb motor function and N20 amplitude in the hemiplegics after stroke.

Key words: stroke, multiple target, intermittent theta burst stimulation, upper extremity

CLC Number:

R743.3

CAO Zhigang,FENG Haixia,LI Yabin,YANG Jiali,LI Jiao,WANG Hongxia,QU Boxuan,ZHANG Yayun. Effects of interhemispheric multi-target intermittent theta burst stimulation on upper limb function in patients with stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(5): 502-507.

Figures/Tables 6

References 40

[1]	GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016 [J]. Lancet, 2017, 390(10100): 1151-1210. doi: 10.1016/S0140-6736(17)32152-9
[2]	EKSTRAND E, BROGARDH C. Life satisfaction after stroke and the association with upper extremity disability, sociodemographics, and participation[J]. [ahead of print]. PM R, 2021, doi: 10.1002/pmrj.12712. doi: 10.1002/pmrj.12712
[3]	LU Y, XIA Y, WU Y, et al. Repetitive transcranial magnetic stimulation for upper limb motor function and activities of daily living in patients with stroke: a protocol of a systematic review and Bayesian network meta-analysis[J]. BMJ Open, 2022, 12(3): e051630. doi: 10.1136/bmjopen-2021-051630
[4]	AGUILAR-FERRANDIZ M E, TOLEDANO-MORENO S, GARCIA-RIOS M C, et al. Effectiveness of a functional rehabilitation program for upper limb apraxia in poststroke patients: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2021, 102(5): 940-950. doi: 10.1016/j.apmr.2020.12.015
[5]	LEVIN M, HIENGKAEW V, NILANONT Y, et al. Relationship between clinical measures of upper limb movement quality and activity poststroke[J]. Neurorehabil Neural Repair, 2019, 33(6): 432-441. doi: 10.1177/1545968319847969
[6]	PATERAKI G, ANARGYROS K, ALOIZOU A M, et al. Therapeutic application of rTMS in neurodegenerative and movement disorders: a review[J]. J Electromyogr Kinesiol, 2022, 62: 102622. doi: 10.1016/j.jelekin.2021.102622
[7]	LEFAUCHEUR J, ALEMAN A, BAEKEN C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018)[J]. Clin Neurophysiol, 2020, 131(2): 474-528. doi: 10.1016/j.clinph.2019.11.002
[8]	VABALAITE B, PETRUSEVICIENE L, SAVICKAS R, et al. Correction: Vabalaite et al. Effects of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) on upper extremity motor function in stroke patients: a systematic review. Medicina 2021, 57, 1215[J]. Medicina (Kaunas), 2022, 58(4): 533.
[9]	VOLZ L J, REHME A K, MICHELY J, et al. Shaping early reorganization of neural networks promotes motor function after stroke[J]. Cereb Cortex, 2016, 26(6): 2882-2894. doi: 10.1093/cercor/bhw034
[10]	LUO J, ZHENG H, ZHANG L, et al. High-frequency repetitive transcranial magnetic stimulation (rTMS) improves functional recovery by enhancing neurogenesis and activating BDNF/TrkB signaling in ischemic rats[J]. Int J Mol Sci, 2017, 18(2): 455. doi: 10.3390/ijms18020455
[11]	DING Q, ZHANG S, CHEN S, et al. The effects of intermittent theta burst stimulation on functional brain network following stroke: an electroencephalography study[J]. Front Neurosci, 2021, 15: 755709. doi: 10.3389/fnins.2021.755709
[12]	LIU X B, ZHONG J G, XIAO X L, et al. Theta burst stimulation for upper limb motor dysfunction in patients with stroke: a protocol of systematic review and meta-analysis[J]. Medicine (Baltimore), 2019, 98(46): e17929. doi: 10.1097/MD.0000000000017929
[13]	MATSUGI A, DOUCHI S, SUZUKI K, et al. Cerebellar transcranial magnetic stimulation reduces the silent period on hand muscle electromyography during force control[J]. Brain Sci, 2020, 10(2): 63. doi: 10.3390/brainsci10020063
[14]	XIE Y J, WEI Q C, CHEN Y, et al. Cerebellar theta burst stimulation on walking function in stroke patients: a randomized clinical trial[J]. Front Neurosci, 2021, 15: 688569. doi: 10.3389/fnins.2021.688569
[15]	MENG Y, ZHANG D, HAI H, et al. Efficacy of coupling intermittent theta-burst stimulation and 1 Hz repetitive transcranial magnetic stimulation to enhance upper limb motor recovery in subacute stroke patients: a randomized controlled trial[J]. Restor Neurol Neurosci, 2020, 38(1): 109-118.
[16]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019 [J]. 中华神经科杂志, 2019, 52(9): 710-715.
	Chinese Society of Neurology, Chinese Stroke Society. Diagnostic Criteria of Cerebrovascular Diseases in China (version 2019)[J]. Chin J Neurol, 2019, 52(9): 710-715.
[17]	KHAW J, SUBRAMANIAM P, ABD AZIZ N A, et al. Current update on the clinical utility of mmse and moca for stroke patients in Asia: a systematic review[J]. Int J Environ Res Public Health, 2021, 18(17): 8962. doi: 10.3390/ijerph18178962
[18]	HERNANDEZ E D, GALEANO C P, BARBOSA N E, et al. Intra- and inter-rater reliability of Fugl-Meyer Assessment of Upper Extremity in stroke[J]. J Rehabil Med, 2019, 51(9): 652-659. doi: 10.2340/16501977-2590
[19]	PRODINGER B, O'CONNOR R J, STUCKI G, et al. Establishing score equivalence of the Functional Independence Measure motor scale and the Barthel Index, utilising the International Classification of Functioning, Disability and Health and Rasch measurement theory[J]. J Rehabil Med, 2017, 49(5): 416-422. doi: 10.2340/16501977-2225
[20]	ZHAO J L, CHEN P M, LI W F, et al. Translation and initial validation of the Chinese version of the Action Research Arm Test in people with stroke[J]. Biomed Res Int, 2019, 2019: 5416560.
[21]	FUSTES O J H, KAY C S K, LORENZONI P J, et al. Somatosensory evoked potentials in clinical practice: a review[J]. Arq Neuropsiquiatr, 2021, 79(9): 824-831. doi: 10.1590/0004-282x-anp-2020-0427
[22]	LIESHOUT E, VAN DE PORT I, DIJKHUIZEN R, et al. Does upper limb strength play a prominent role in health-related quality of life in stroke patients discharged from inpatient rehabilitation?[J]. Top Stroke Rehabil, 2020, 27(7): 525-533. doi: 10.1080/10749357.2020.1738662
[23]	XU A H, SUN Y X. Research hotspots and effectiveness of repetitive transcranial magnetic stimulation in stroke rehabilitation[J]. Neural Regen Res, 2020, 15(11): 2089-2097. doi: 10.4103/1673-5374.282269
[24]	LUDEMANN-PODUBECKA J, NEUMANN G, PONFICK M, et al. [Repetitive transcranial magnetic stimulation for the upper limb motor function improvement after stroke][J]. [in German]. Fortschr Neurol Psychiatr, 2014, 82(3): 135-144.
[25]	FRANCA C, DE ANDRADE D C, TEIXEIRA M J, et al. Effects of cerebellar neuromodulation in movement disorders: a systematic review[J]. Brain Stimul, 2018, 11(2): 249-260. doi: 10.1016/j.brs.2017.11.015
[26]	KOCH G, BONNI S, CASULA E P, et al. Effect of cerebellar stimulation on gait and balance recovery in patients with hemiparetic stroke: a randomized clinical trial[J]. JAMA Neurol, 2019, 76(2): 170-178. doi: 10.1001/jamaneurol.2018.3639
[27]	DU J, YANG F, HU J, et al. Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients: evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments[J]. Neuroimage Clin, 2019, 21: 101620. doi: 10.1016/j.nicl.2018.101620
[28]	LI J, MENG X M, LI R Y, et al. Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction[J]. Neural Regen Res, 2016, 11(10): 1584-1590. doi: 10.4103/1673-5374.193236
[29]	TAKEUCHI N, IZUMI S I. [Rehabilitation using repetitive transcranial magnetic stimulation][J]. [in Japanese]. Brain Nerve, 2017, 69(3): 227-238.
[30]	CHEN Q M, YAO F R, SUN H W, et al. Combining inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment improves motor function by modulating GABA in acute ischemic stroke patients[J]. Restor Neurol Neurosci, 2021, 39(6): 419-434.
[31]	STAROSTA M, CICHON N, SALUK-BIJAK J, et al. Benefits from repetitive transcranial magnetic stimulation in post-stroke rehabilitation[J]. J Clin Med, 2022, 11(8): 2149. doi: 10.3390/jcm11082149
[32]	ZONG X, LI Y, LIU C, et al. Theta-burst transcranial magnetic stimulation promotes stroke recovery by vascular protection and neovascularization[J]. Theranostics, 2020, 10(26): 12090-12110. doi: 10.7150/thno.51573
[33]	LI J, ZHANG X W, ZUO Z T, et al. Cerebral functional reorganization in ischemic stroke after repetitive transcranial magnetic stimulation: an fMRI Study[J]. CNS Neurosci Ther, 2016, 22(12): 952-960. doi: 10.1111/cns.12593
[34]	SCHULZ R, PARK E, LEE J, et al. Synergistic but independent: the role of corticospinal and alternate motor fibers for residual motor output after stroke[J]. Neuroimage Clin, 2017, 15: 118-124. doi: 10.1016/j.nicl.2017.04.016
[35]	WANG C P, TSAI P Y, YANG T F, et al. Differential effect of conditioning sequences in coupling inhibitory/facilitatory repetitive transcranial magnetic stimulation for poststroke motor recovery[J]. CNS Neurosci Ther, 2014, 20(4): 355-363. doi: 10.1111/cns.12221
[36]	ZHENG Y, MAO Y, YUAN T, et al. Multimodal treatment for spinal cord injury: a sword of neuroregeneration upon neuromodulation[J]. Neural Regen Res, 2020, 15(8): 1437-1450. doi: 10.4103/1673-5374.274332
[37]	DI LAZZARO V, ROTHWELL J C. Corticospinal activity evoked and modulated by non-invasive stimulation of the intact human motor cortex[J]. J Physiol, 2014, 592(19): 4115-4128. doi: 10.1113/jphysiol.2014.274316
[38]	CHANG W H, KIM Y H, YOO W K, et al. rTMS with motor training modulates cortico-basal ganglia-thalamocortical circuits in stroke patients[J]. Restor Neurol Neurosci, 2012, 30(3): 179-189.
[39]	XU R, ZHU G, ZHU J, et al. Using Hebbian-type stimulation to rescue arm function after stroke: study protocol for a randomized clinical trial[J]. Front Neural Circuits, 2021, 15: 789095. doi: 10.3389/fncir.2021.789095
[40]	BONNI S, PONZO V, CALTAGIRONE C, et al. Cerebellar theta burst stimulation in stroke patients with ataxia[J]. Funct Neurol, 2014, 29(1): 41-45.

组别	n	性别(男/女)/n	年龄/岁	病程/d	受损半球(左/右)/n
单靶区刺激组	20	11/9	48.75±13.24	41.90±24.86	13/7
多靶区刺激组	20	12/8	51.80±15.45	45.85±20.56	8/12
χ²/t值			0.670	0.547
P值		1.000^a	0.507	0.587	1.000^a

组别	n	治疗前	治疗后	t值	P值
单靶区刺激组	20	14.90±5.80	28.05±8.26	10.566	< 0.001
多靶区刺激组	20	16.75±6.23	37.20±5.77	16.454	< 0.001
t值		0.972	4.060
P值		0.337	< 0.001

组别	n	治疗前	治疗后	t值	P值
单靶区刺激组	20	35.55±14.78	72.00±12.43	14.936	< 0.001
多靶区刺激组	20	36.20±19.78	76.80±12.14	10.901	< 0.001
t值		0.118	1.235
P值		0.907	0.225

组别	n	治疗前	治疗后	Z值	P值
单靶区刺激组	20	7.50 (5.00,15.50)	9.50 (7.25,15.00)	-2.243	0.025
多靶区刺激组	20	6.50 (4.00,16.75)	20.00 (10.25,25.00)	-3.727	< 0.001
Z值		0.748	-2.697
P值		0.455	0.007

组别	n	治疗前	治疗后	t值	P值
单靶区刺激组	20	27.77±2.31	27.33±2.31	3.478	0.003
多靶区刺激组	20	27.21±3.78	26.57±3.41	5.467	< 0.001
t值		-0.612	-0.831
P值		0.544	0.411

Effects of interhemispheric multi-target intermittent theta burst stimulation on upper limb function in patients with stroke

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组别	n	治疗前	治疗后	t值	P值
单靶区刺激组	20	0.71±0.27	1.01±0.39	-3.572	0.002
多靶区刺激组	20	0.69±0.31	1.37±0.37	-8.876	< 0.001
t值		-0.215	2.939
P值		0.831	0.006

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