Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:3...Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.展开更多
Prolife ration of neural stem cells is crucial for promoting neuronal regeneration and repairing cerebral infarction damage.Transcranial magnetic stimulation(TMS)has recently emerged as a tool for inducing endogenous ...Prolife ration of neural stem cells is crucial for promoting neuronal regeneration and repairing cerebral infarction damage.Transcranial magnetic stimulation(TMS)has recently emerged as a tool for inducing endogenous neural stem cell regeneration,but its underlying mechanisms remain unclea r In this study,we found that repetitive TMS effectively promotes the proliferation of oxygen-glucose deprived neural stem cells.Additionally,repetitive TMS reduced the volume of cerebral infa rction in a rat model of ischemic stro ke caused by middle cerebral artery occlusion,im p roved rat cognitive function,and promoted the proliferation of neural stem cells in the ischemic penumbra.RNA-sequencing found that repetitive TMS activated the Wnt signaling pathway in the ischemic penumbra of rats with cerebral ischemia.Furthermore,PCR analysis revealed that repetitive TMS promoted AKT phosphorylation,leading to an increase in mRNA levels of cell cycle-related proteins such as Cdk2 and Cdk4.This effect was also associated with activation of the glycogen synthase kinase 3β/β-catenin signaling pathway,which ultimately promotes the prolife ration of neural stem cells.Subsequently,we validated the effect of repetitive TMS on AKT phosphorylation.We found that repetitive TMS promoted Ca2+influx into neural stem cells by activating the P2 calcium channel/calmodulin pathway,thereby promoting AKT phosphorylation and activating the glycogen synthase kinase 3β/β-catenin pathway.These findings indicate that repetitive TMS can promote the proliferation of endogenous neural stem cells through a Ca2+influx-dependent phosphorylated AKT/glycogen synthase kinase 3β/β-catenin signaling pathway.This study has produced pioneering res ults on the intrinsic mechanism of repetitive TMS to promote neural function recove ry after ischemic stro ke.These results provide a stro ng scientific foundation for the clinical application of repetitive TMS.Moreover,repetitive TMS treatment may not only be an efficient and potential approach to support neurogenesis for further therapeutic applications,but also provide an effective platform for the expansion of neural stem cells.展开更多
BACKGROUND Repetitive transcranial magnetic stimulation(rTMS)is a form of magnetic stimulation therapy used to treat depression,migraine,and motor function impairment in patients with stroke.As there is little researc...BACKGROUND Repetitive transcranial magnetic stimulation(rTMS)is a form of magnetic stimulation therapy used to treat depression,migraine,and motor function impairment in patients with stroke.As there is little research on the effects of rTMS in pregnant women,it is not widely used in these patients.This case report aimed to demonstrate the safety of rTMS in pregnant patients.CASE SUMMARY After much consideration,we applied rTMS to treat recent stroke and hemiplegia in a 34-year-old pregnant woman.The patient received 45 sessions of lowfrequency treatment over the course of 10 wk.We closely monitored the mother and fetus for potential side effects;the results showed significant improvement in the patient's motor function,with no harmful effects on the mother or fetus during pregnancy or after delivery.The patient’s fine motor and walking functions improved after treatment.This case is the first instance of a stroke patient treated with rTMS during pregnancy.CONCLUSION This case demonstrates that rTMS could be used to improve motor function recovery in stroke patients during pregnancy.展开更多
BACKGROUND Dysphagia is a common condition in older as well as young patients,and a variety of treatments have been reported depending on the cause.However,clinicians are challenged when the cause is unclear.This is t...BACKGROUND Dysphagia is a common condition in older as well as young patients,and a variety of treatments have been reported depending on the cause.However,clinicians are challenged when the cause is unclear.This is the case with psychogenic dysphagia,which has typically been treated with supportive psychotherapy,medi-cation,swallowing exercise,and dysphagia rehabilitation therapy.Here,we aimed to relieve the symptoms of a patient with refractory psychogenic dysphagia,who was unresponsive to conventional swallowing therapy,with repetitive transcranial magnetic stimulation(rTMS).CASE SUMMARY A relatively calm-looking 35-year-old female patient presented with a 2-year history of dysphagia.She showed little improvement with conventional swallowing treatments over the past 2 years.She was relatively compliant with inhospital dysphagia therapy,but uncooperative with home exercise and medication.In particular,since she was resistant to drug treatment,we had to take a different approach than the treatment she had been receiving for the past 2 years.After much deliberation,we decided to initiate antidepressant rTMS treatment with her consent(IRB No.2023-05-021).Antidepressant rTMS treatment was performed twice weekly for a total of 20 sessions over 10 wk.The results showed improvement in subjective symptoms and video fluoroscopic swallowing study findings.To the best of our knowledge,this is the first report of symptomatic improvement using antidepressant rTMS protocol for refractory psychogenic dysphagia.CONCLUSION This case demonstrates that rTMS with antidepressant protocol can be used to improve swallowing in patients with refractory psychogenic dysphagia.展开更多
No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest res...No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest research indicates that when combined with local injections of botulinum toxin type A,it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone.We designed a prospective,single-center,non-randomized,controlled clinical trial to investigate the safety and effica cy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen.This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hos pital of China Medical Unive rsity.All enrolled patients will undergo ro utine rehabilitation training and will be divided into five groups in-30 per group) according to the particular area of cerebral infa rction and treatment methods.G roup A:Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency(1 Hz)repetitive transcranial magnetic stimulation on the contralate ral side;G roup B:Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency(10-20 Hz) re petitive transcranial magnetic stimulation on the affected side;G roup C:Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A;G roup D:Patients with massive cerebral infarction will be given low-frequency(1 Hz) repetitive transcranial magnetic stimulation on the contralate ral side;and G roup E:Patients with non-massive cerebral infa rction will be given high-frequency(10-20 Hz) repetitive transcranial magnetic stimulation on the affected side.The primary outcome measure of this trial is a modified Ashwo rth scale score from 1 day before treatment to 12 months after treatment.Secondary outcome measures include Fugl-M eyer Assessment of Lower Extremity,Visual Analogue Scale,modified Barthel index,and Berg Balance Scale scores for the same time as specified for primary outcome measures.The safety indicator is the incidence of adverse events at 3-12 months after treatment.We hope to draw a definite conclusion on whether there are diffe rences in the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation,thereby screening out the optimal therapeutic regimen.The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University(approval No.[2021] 2021-333-3) on August 19,2021.The trial was registe red with the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052180) on October 21,2021.The protocol version is 1.1.展开更多
Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the ex...Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex (M1). The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.展开更多
Repetitive transcranial magnetic stimulation, as a relatively new type of rehabilitation treatment, is a painless and non-invasive method for altering brain excitability. Repetitive transcranial magnetic stimulation h...Repetitive transcranial magnetic stimulation, as a relatively new type of rehabilitation treatment, is a painless and non-invasive method for altering brain excitability. Repetitive transcranial magnetic stimulation has been widely used in the neurorehabilitation of stroke patients. Here, we used CiteSpace software to visually analyze 315 studies concerning repetitive transcranial magnetic stimulation for stroke rehabilitation from 1999 to 2019, indexed by Web of Science, to clarify the research hotspots in different periods and characterize the gradual process of discovery in this field. We found that four main points were generally accepted:(1) repetitive transcranial magnetic stimulation has a positive effect on motor function recovery in patients with subcortical stroke;(2) it may be more advantageous for stroke patients to receive low-frequency repetitive transcranial magnetic stimulation in the unaffected hemispheres than to receive high-frequency repetitive transcranial magnetic stimulation in affected hemisphere;(3) low-frequency repetitive transcranial magnetic stimulation has become a potential therapeutic tool for patients with non-fluent aphasia after chronic stroke for neurological rehabilitation and language recovery;and(4) there are some limitations to these classic clinical studies, such as small sample size and low test efficiency. Our assessment indicates that prospective, multi-center, large-sample, randomized controlled clinical trials are still needed to further verify the effectiveness of various repetitive transcranial magnetic stimulation programs for the rehabilitation of stroke patients.展开更多
Proper stimulation to affected cerebral hemisphere would promote the functional recovery of patients with stroke. Effects of repetitive transcranial magnetic stimulation on cortical excitability can be can be altered ...Proper stimulation to affected cerebral hemisphere would promote the functional recovery of patients with stroke. Effects of repetitive transcranial magnetic stimulation on cortical excitability can be can be altered by the stimulation frequency, intensity and duration. There has been no consistent recognition regarding the best stimulation frequency and intensity. This study reviews the intervention effects of repetitive transcranial stimulation on motor impairment, dysphagia, visuospatial neglect and aphasia, and summarizes the stimulation frequency, intensity and area for repetitive transcranial magnetic stimulation to yield the best therapeutic effects.展开更多
Very little is known about the effects of transcranial magnetic stimulation and rehabilitation training on pyramidal cell dendrites and synapses of the contralateral, unaffected sensorimotor cortex in a rat model of f...Very little is known about the effects of transcranial magnetic stimulation and rehabilitation training on pyramidal cell dendrites and synapses of the contralateral, unaffected sensorimotor cortex in a rat model of focal cerebral infarct. The present study was designed to explore the mechanisms underlying improved motor function via transcranial magnetic stimulation and rehabilitation training following cerebral infarction. Results showed that rehabilitation training or transcranial magnetic stimulation alone reduced neurological impairment in rats following cerebral infarction, as well as significantly increased synaptic curvatures and post-synaptic density in the non-injured cerebral hemisphere sensorimotor cortex and narrowed the synapse cleft width. In addition, the percentage of perforated synapses increased. The combination of transcranial magnetic stimulation and rehabilitation resulted in significantly increased total dendritic length, dendritic branching points, and dendritic density in layer V pyramidal cells of the non-injured cerebral hemisphere motor cortex. These results demonstrated that transcranial magnetic stimulation and rehabilitation training altered structural parameters of pyramidal cell dendrites and synapses in the non-injured cerebral hemisphere sensorimotor cortex, thereby improving the ability to compensate for neurological functions in rats following cerebral infarction.展开更多
Following a spinal cord injury,there are usually a number of neural pathways that remain intact in the spinal cord.These residual nerve fibers are important,as they could be used to reconstruct the neural circuits tha...Following a spinal cord injury,there are usually a number of neural pathways that remain intact in the spinal cord.These residual nerve fibers are important,as they could be used to reconstruct the neural circuits that enable motor function.Our group previously designed a novel magnetic stimulation protocol,targeting the motor cortex and the spinal nerve roots,that led to significant improvements in locomotor function in patients with a chronic incomplete spinal cord injury.Here,we investigated how nerve root magnetic stimulation contributes to improved locomotor function using a rat model of spinal cord injury.Rats underwent surgery to clamp the spinal cord at T10;three days later,the rats were treated with repetitive magnetic stimulation(5 Hz,25 pulses/train,20 pulse trains)targeting the nerve roots at the L5-L6 vertebrae.The treatment was repeated five times a week over a period of three weeks.We found that the nerve root magnetic stimulation improved the locomotor function and enhanced nerve conduction in the injured spinal cord.In addition,the nerve root magnetic stimulation promoted the recovery of synaptic ultrastructure in the sensorimotor cortex.Overall,the results suggest that nerve root magnetic stimulation may be an effective,noninvasive method for mobilizing the residual spinal cord pathways to promote the recovery of locomotor function.展开更多
BACKGROUND: The detection of motor evoked potential is utilized to explore neuromuscular finger coordination. The influence of transcranial magnetic stimulation on finger force has been investigated mainly on a singl...BACKGROUND: The detection of motor evoked potential is utilized to explore neuromuscular finger coordination. The influence of transcranial magnetic stimulation on finger force has been investigated mainly on a single finger, and only time-dependent increased target finger force has been detected in the finger force task. OBJECTIVE: To explore the neural mechanism of finger force coordination in the motor cortex by observing the influence of various finger coordination patterns and patterns of transcranial magnetic stimulation (TMS)-induced finger force changes. DESIGN, TIME AND SETTING: Neurophysiological and behavioral study was performed at the Biomedical Engineering Laboratory of Chongqing University from April to June 2008. PARTICIPANTS: A total of 10 healthy, university students, comprising 5 males and 5 females, aged 21-23 years, voluntarily participated in this study. All participants were right-handed, with normal or corrected vision. Individuals with upper limb complaints or other musculoskeletal disorders were excluded. METHODS: A target force-tracking task was conducted on the index finger, the index and middle fingers, and four fingers (index, middle, ring, and little), respectively. Target force trace in a single trial consisted of a 6-second ramp phase, a 20-second constant phase, and a 6-second drop phase. During experimentation, an unpredictable single-pulse TMS (120% motor threshold) was applied to the primary motor cortex (M1) in each phase. MAIN OUTCOME MEASURES: Changes in peak force induced by TMS were obtained for each finger pattern during each force-tracking phase. Differences in force changes were tested between different finger pattems with regard to ramp, constant, and drop phases of target force. RESULTS: Under ramp, constant, and drop phases of target force, the increase in magnetic stimulation-induced finger forces changes positively correlated with the number of fingers involved in the force tracking task. The magnetic stimulation-induced force changes from the index finger were less than the combination of the index and middle fingers or all four fingers under the corresponding target force, and the force changes from the combination of the index and middle fingers were less than all four fingers, Le., index finger 〈 index and middle fingers 〈 four fingers. CONCLUSION: Different neuromuscular mechanisms could be involved in finger force production for different finger combination patterns. Results from the present study suggested that independent motor neurons regulated individual finger force production.展开更多
目的:研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcranial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法:选取2019年1月至2023年6月某部队康复中心收治的198例卒中后遗留有运动功能障碍患...目的:研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcranial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法:选取2019年1月至2023年6月某部队康复中心收治的198例卒中后遗留有运动功能障碍患者,采用随机数字表法分为三组,各66例。三组均给予常规康复指导,磁刺激组给予TMS治疗,镜像组给予MNS治疗,联合组给予TMS+MNS治疗。比较三组干预前、干预2周后、干预4周后神经功能(NIHSS)、上下肢运动功能(FMA)、日常生活能力(ADL)、平衡能力(BBS)、上肢与下肢肌张力(MAS)、健患侧步长差、患侧负重时间百分比及语言功能。结果:联合组干预2周、4周后NIHSS评分低于磁刺激组、镜像组,差异具有统计学意义(P<0.05),磁刺激组、镜像组组间比较,差异无统计学意义(P>0.05);联合组干预2周、4周后FMA-上肢、FMA-下肢评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后ADL评分、BBS评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预4周后上肢和下肢MAS分级0~1级患者占比高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05);联合组干预2周、4周后健患侧步长差低于磁刺激组、镜像组,患侧负重时间百分比高于磁刺激组、镜像组,且镜像组变化幅度大于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后语言功能中阅读理解、复述、流畅度、命名评分高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05)。结论:MNS联合TMS能促进卒中后神经与功能康复,有利于改善患者日常生活能力,且二者各有优势,互相补充,联合治疗效果显著,值得临床推广。展开更多
帕金森病(Parkinson disease,PD)患者多数会出现言语功能障碍,严重影响生活质量。近年重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)在治疗PD患者言语障碍的临床实践中取得了新的进展。研究结果提示,将rTMS作用...帕金森病(Parkinson disease,PD)患者多数会出现言语功能障碍,严重影响生活质量。近年重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)在治疗PD患者言语障碍的临床实践中取得了新的进展。研究结果提示,将rTMS作用于初级运动皮质(primary motor cortex,M1)的口面部区域和颞上回(superior temporal gyrus,STG)可能会有效地改善PD患者的言语功能,现有研究未见报道有由rTMS引起的严重不良反应。rTMS治疗PD患者言语障碍的机制可能与rTMS可以调节言语相关大脑皮质(如M1和STG)的兴奋性和功能连接程度有关。总结来说,rTMS在PD言语障碍的治疗中取得了良好的效果,但目前研究的数量较少,未来还需要更多大规模和大样本量的随机对照试验来进一步验证和支持其效果。展开更多
脑卒中是一种高发病率的急性脑血管疾病,常伴随肢体运动功能障碍的后遗症。经颅磁刺激(transcranial magnetic stimulation,TMS)作为一种非侵入式的脑刺激方法,大量临床实验证明其对卒中后运动功能障碍有明显的康复作用,但背后的神经康...脑卒中是一种高发病率的急性脑血管疾病,常伴随肢体运动功能障碍的后遗症。经颅磁刺激(transcranial magnetic stimulation,TMS)作为一种非侵入式的脑刺激方法,大量临床实验证明其对卒中后运动功能障碍有明显的康复作用,但背后的神经康复机制仍不明确,需要更多的研究和探索。本文从TMS在运动功能评估、干预和康复预测模型的建立等方面入手,梳理、总结了近年来TMS在脑卒中运动康复领域的发展进程和研究现状,以期为后续研究提供参考。展开更多
文摘Objective:To analyze the effect of limb rehabilitation therapy combined with transcranial magnetic stimulation therapy on muscle activity in patients with upper limb dysfunction after cerebral infarction(CI).Methods:320 patients with upper limb dysfunction after CI were selected,all of whom were treated in our hospital between June 2021 and June 2023.They were randomly grouped according to the lottery method into the control group(limb rehabilitation therapy,160 cases)and the intervention group(transcranial magnetic stimulation therapy+limb rehabilitation therapy,160 cases).The upper limb function scores,neuro-electrophysiological indicators,daily living ability scores,and quality of life scores of the two groups were compared.Results:Compared with the control group,upper limb function scores and daily living ability scores in the intervention group were higher after treatment,and the neuro-electrophysiological indicators of the intervention group were lower after treatment(P<0.05).Conclusion:Transcranial magnetic stimulation therapy combined with limb rehabilitation therapy has significant effects in patients with upper limb dysfunction after CI and is worthy of promotion and application.
基金supported by the National Natural Science Foundation of China,Nos.81672261(to XH),81972151(to HZ),82372568(to JL)the Natural Science Foundation of Guangdong Province,Nos.2019A1515011106(to HZ),2023A1515030080(to JL)。
文摘Prolife ration of neural stem cells is crucial for promoting neuronal regeneration and repairing cerebral infarction damage.Transcranial magnetic stimulation(TMS)has recently emerged as a tool for inducing endogenous neural stem cell regeneration,but its underlying mechanisms remain unclea r In this study,we found that repetitive TMS effectively promotes the proliferation of oxygen-glucose deprived neural stem cells.Additionally,repetitive TMS reduced the volume of cerebral infa rction in a rat model of ischemic stro ke caused by middle cerebral artery occlusion,im p roved rat cognitive function,and promoted the proliferation of neural stem cells in the ischemic penumbra.RNA-sequencing found that repetitive TMS activated the Wnt signaling pathway in the ischemic penumbra of rats with cerebral ischemia.Furthermore,PCR analysis revealed that repetitive TMS promoted AKT phosphorylation,leading to an increase in mRNA levels of cell cycle-related proteins such as Cdk2 and Cdk4.This effect was also associated with activation of the glycogen synthase kinase 3β/β-catenin signaling pathway,which ultimately promotes the prolife ration of neural stem cells.Subsequently,we validated the effect of repetitive TMS on AKT phosphorylation.We found that repetitive TMS promoted Ca2+influx into neural stem cells by activating the P2 calcium channel/calmodulin pathway,thereby promoting AKT phosphorylation and activating the glycogen synthase kinase 3β/β-catenin pathway.These findings indicate that repetitive TMS can promote the proliferation of endogenous neural stem cells through a Ca2+influx-dependent phosphorylated AKT/glycogen synthase kinase 3β/β-catenin signaling pathway.This study has produced pioneering res ults on the intrinsic mechanism of repetitive TMS to promote neural function recove ry after ischemic stro ke.These results provide a stro ng scientific foundation for the clinical application of repetitive TMS.Moreover,repetitive TMS treatment may not only be an efficient and potential approach to support neurogenesis for further therapeutic applications,but also provide an effective platform for the expansion of neural stem cells.
文摘BACKGROUND Repetitive transcranial magnetic stimulation(rTMS)is a form of magnetic stimulation therapy used to treat depression,migraine,and motor function impairment in patients with stroke.As there is little research on the effects of rTMS in pregnant women,it is not widely used in these patients.This case report aimed to demonstrate the safety of rTMS in pregnant patients.CASE SUMMARY After much consideration,we applied rTMS to treat recent stroke and hemiplegia in a 34-year-old pregnant woman.The patient received 45 sessions of lowfrequency treatment over the course of 10 wk.We closely monitored the mother and fetus for potential side effects;the results showed significant improvement in the patient's motor function,with no harmful effects on the mother or fetus during pregnancy or after delivery.The patient’s fine motor and walking functions improved after treatment.This case is the first instance of a stroke patient treated with rTMS during pregnancy.CONCLUSION This case demonstrates that rTMS could be used to improve motor function recovery in stroke patients during pregnancy.
文摘BACKGROUND Dysphagia is a common condition in older as well as young patients,and a variety of treatments have been reported depending on the cause.However,clinicians are challenged when the cause is unclear.This is the case with psychogenic dysphagia,which has typically been treated with supportive psychotherapy,medi-cation,swallowing exercise,and dysphagia rehabilitation therapy.Here,we aimed to relieve the symptoms of a patient with refractory psychogenic dysphagia,who was unresponsive to conventional swallowing therapy,with repetitive transcranial magnetic stimulation(rTMS).CASE SUMMARY A relatively calm-looking 35-year-old female patient presented with a 2-year history of dysphagia.She showed little improvement with conventional swallowing treatments over the past 2 years.She was relatively compliant with inhospital dysphagia therapy,but uncooperative with home exercise and medication.In particular,since she was resistant to drug treatment,we had to take a different approach than the treatment she had been receiving for the past 2 years.After much deliberation,we decided to initiate antidepressant rTMS treatment with her consent(IRB No.2023-05-021).Antidepressant rTMS treatment was performed twice weekly for a total of 20 sessions over 10 wk.The results showed improvement in subjective symptoms and video fluoroscopic swallowing study findings.To the best of our knowledge,this is the first report of symptomatic improvement using antidepressant rTMS protocol for refractory psychogenic dysphagia.CONCLUSION This case demonstrates that rTMS with antidepressant protocol can be used to improve swallowing in patients with refractory psychogenic dysphagia.
文摘No definite consensus has currently been reached regarding the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation in the treatment of post-stroke muscle spasticity.The latest research indicates that when combined with local injections of botulinum toxin type A,it is more effective on post-stroke muscle spasticity than local injections of botulinum toxin type A alone.We designed a prospective,single-center,non-randomized,controlled clinical trial to investigate the safety and effica cy of different frequencies of repetitive transcranial magnetic stimulation combined with local injections of botulinum toxin type A in treating post-stroke lower limb muscle spasticity to determine an optimal therapeutic regimen.This trial will enroll 150 patients with post-stroke muscle spasticity admitted to the Department of Rehabilitation Medicine at the First Affiliated Hos pital of China Medical Unive rsity.All enrolled patients will undergo ro utine rehabilitation training and will be divided into five groups in-30 per group) according to the particular area of cerebral infa rction and treatment methods.G roup A:Patients with massive cerebral infarction will be given local injections of botulinum toxin type A and low-frequency(1 Hz)repetitive transcranial magnetic stimulation on the contralate ral side;G roup B:Patients with non-massive cerebral infarction will be given local injections of botulinum toxin type A and high-frequency(10-20 Hz) re petitive transcranial magnetic stimulation on the affected side;G roup C:Patients with massive/non-massive cerebral infarction will be given local injections of botulinum toxin type A;G roup D:Patients with massive cerebral infarction will be given low-frequency(1 Hz) repetitive transcranial magnetic stimulation on the contralate ral side;and G roup E:Patients with non-massive cerebral infa rction will be given high-frequency(10-20 Hz) repetitive transcranial magnetic stimulation on the affected side.The primary outcome measure of this trial is a modified Ashwo rth scale score from 1 day before treatment to 12 months after treatment.Secondary outcome measures include Fugl-M eyer Assessment of Lower Extremity,Visual Analogue Scale,modified Barthel index,and Berg Balance Scale scores for the same time as specified for primary outcome measures.The safety indicator is the incidence of adverse events at 3-12 months after treatment.We hope to draw a definite conclusion on whether there are diffe rences in the safety and efficacy of low-or high-frequency repetitive transcranial magnetic stimulation combined with botulinum toxin type A injections in the treatment of patients with post-stroke lower limb spasticity under strict grouping and standardized operation,thereby screening out the optimal therapeutic regimen.The study protocol was approved by the Medical Ethics Committee of the First Affiliated Hospital of China Medical University(approval No.[2021] 2021-333-3) on August 19,2021.The trial was registe red with the Chinese Clinical Trial Registry(Registration No.ChiCTR2100052180) on October 21,2021.The protocol version is 1.1.
基金several colleague therapists of the Rehabilitation Medicine Department of the Affiliated Hospital of Qingdao University of China for their support and selfless help
文摘Studies have confirmed that low-frequency repetitive transcranial magnetic stimulation can decrease the activity of cortical neurons, and high-frequency repetitive transcranial magnetic stimulation can increase the excitability of cortical neurons. However, there are few studies concerning the use of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper-limb motor function after cerebral infarction. We hypothesized that different frequencies of repetitive transcranial magnetic stimulation in patients with cerebral infarction would produce different effects on the recovery of upper-limb motor function. This study enrolled 127 patients with upper-limb dysfunction during the subacute phase of cerebral infarction. These patients were randomly assigned to three groups. The low-frequency group comprised 42 patients who were treated with 1 Hz repetitive transcranial magnetic stimulation on the contralateral hemisphere primary motor cortex (M1). The high-frequency group comprised 43 patients who were treated with 10 Hz repetitive transcranial magnetic stimulation on ipsilateral M1. Finally, the sham group comprised 42 patients who were treated with 10 Hz of false stimulation on ipsilateral M1. A total of 135 seconds of stimulation was applied in the sham group and high-frequency group. At 2 weeks after treatment, cortical latency of motor-evoked potentials and central motor conduction time were significantly lower compared with before treatment. Moreover, motor function scores were significantly improved. The above indices for the low- and high-frequency groups were significantly different compared with the sham group. However, there was no significant difference between the low- and high-frequency groups. The results show that low- and high-frequency repetitive transcranial magnetic stimulation can similarly improve upper-limb motor function in patients with cerebral infarction.
文摘Repetitive transcranial magnetic stimulation, as a relatively new type of rehabilitation treatment, is a painless and non-invasive method for altering brain excitability. Repetitive transcranial magnetic stimulation has been widely used in the neurorehabilitation of stroke patients. Here, we used CiteSpace software to visually analyze 315 studies concerning repetitive transcranial magnetic stimulation for stroke rehabilitation from 1999 to 2019, indexed by Web of Science, to clarify the research hotspots in different periods and characterize the gradual process of discovery in this field. We found that four main points were generally accepted:(1) repetitive transcranial magnetic stimulation has a positive effect on motor function recovery in patients with subcortical stroke;(2) it may be more advantageous for stroke patients to receive low-frequency repetitive transcranial magnetic stimulation in the unaffected hemispheres than to receive high-frequency repetitive transcranial magnetic stimulation in affected hemisphere;(3) low-frequency repetitive transcranial magnetic stimulation has become a potential therapeutic tool for patients with non-fluent aphasia after chronic stroke for neurological rehabilitation and language recovery;and(4) there are some limitations to these classic clinical studies, such as small sample size and low test efficiency. Our assessment indicates that prospective, multi-center, large-sample, randomized controlled clinical trials are still needed to further verify the effectiveness of various repetitive transcranial magnetic stimulation programs for the rehabilitation of stroke patients.
基金supported by grant of the Korea Healthcare technology R&D Project, Ministry of Health & Welfare, Republic of Korea, No. A101901
文摘Proper stimulation to affected cerebral hemisphere would promote the functional recovery of patients with stroke. Effects of repetitive transcranial magnetic stimulation on cortical excitability can be can be altered by the stimulation frequency, intensity and duration. There has been no consistent recognition regarding the best stimulation frequency and intensity. This study reviews the intervention effects of repetitive transcranial stimulation on motor impairment, dysphagia, visuospatial neglect and aphasia, and summarizes the stimulation frequency, intensity and area for repetitive transcranial magnetic stimulation to yield the best therapeutic effects.
基金Yantai Science and Technology Development Projects, No. 2008142-5
文摘Very little is known about the effects of transcranial magnetic stimulation and rehabilitation training on pyramidal cell dendrites and synapses of the contralateral, unaffected sensorimotor cortex in a rat model of focal cerebral infarct. The present study was designed to explore the mechanisms underlying improved motor function via transcranial magnetic stimulation and rehabilitation training following cerebral infarction. Results showed that rehabilitation training or transcranial magnetic stimulation alone reduced neurological impairment in rats following cerebral infarction, as well as significantly increased synaptic curvatures and post-synaptic density in the non-injured cerebral hemisphere sensorimotor cortex and narrowed the synapse cleft width. In addition, the percentage of perforated synapses increased. The combination of transcranial magnetic stimulation and rehabilitation resulted in significantly increased total dendritic length, dendritic branching points, and dendritic density in layer V pyramidal cells of the non-injured cerebral hemisphere motor cortex. These results demonstrated that transcranial magnetic stimulation and rehabilitation training altered structural parameters of pyramidal cell dendrites and synapses in the non-injured cerebral hemisphere sensorimotor cortex, thereby improving the ability to compensate for neurological functions in rats following cerebral infarction.
基金supported by the National Natural Science Foundation of China(General Program),Nos.81772453,81974358(both to DSX).
文摘Following a spinal cord injury,there are usually a number of neural pathways that remain intact in the spinal cord.These residual nerve fibers are important,as they could be used to reconstruct the neural circuits that enable motor function.Our group previously designed a novel magnetic stimulation protocol,targeting the motor cortex and the spinal nerve roots,that led to significant improvements in locomotor function in patients with a chronic incomplete spinal cord injury.Here,we investigated how nerve root magnetic stimulation contributes to improved locomotor function using a rat model of spinal cord injury.Rats underwent surgery to clamp the spinal cord at T10;three days later,the rats were treated with repetitive magnetic stimulation(5 Hz,25 pulses/train,20 pulse trains)targeting the nerve roots at the L5-L6 vertebrae.The treatment was repeated five times a week over a period of three weeks.We found that the nerve root magnetic stimulation improved the locomotor function and enhanced nerve conduction in the injured spinal cord.In addition,the nerve root magnetic stimulation promoted the recovery of synaptic ultrastructure in the sensorimotor cortex.Overall,the results suggest that nerve root magnetic stimulation may be an effective,noninvasive method for mobilizing the residual spinal cord pathways to promote the recovery of locomotor function.
基金the National Natural Science Foundation of China, No. 3077054630970758+1 种基金Chongqing Natural Science Foundation, No. 2006BB2043 2007BB5148
文摘BACKGROUND: The detection of motor evoked potential is utilized to explore neuromuscular finger coordination. The influence of transcranial magnetic stimulation on finger force has been investigated mainly on a single finger, and only time-dependent increased target finger force has been detected in the finger force task. OBJECTIVE: To explore the neural mechanism of finger force coordination in the motor cortex by observing the influence of various finger coordination patterns and patterns of transcranial magnetic stimulation (TMS)-induced finger force changes. DESIGN, TIME AND SETTING: Neurophysiological and behavioral study was performed at the Biomedical Engineering Laboratory of Chongqing University from April to June 2008. PARTICIPANTS: A total of 10 healthy, university students, comprising 5 males and 5 females, aged 21-23 years, voluntarily participated in this study. All participants were right-handed, with normal or corrected vision. Individuals with upper limb complaints or other musculoskeletal disorders were excluded. METHODS: A target force-tracking task was conducted on the index finger, the index and middle fingers, and four fingers (index, middle, ring, and little), respectively. Target force trace in a single trial consisted of a 6-second ramp phase, a 20-second constant phase, and a 6-second drop phase. During experimentation, an unpredictable single-pulse TMS (120% motor threshold) was applied to the primary motor cortex (M1) in each phase. MAIN OUTCOME MEASURES: Changes in peak force induced by TMS were obtained for each finger pattern during each force-tracking phase. Differences in force changes were tested between different finger pattems with regard to ramp, constant, and drop phases of target force. RESULTS: Under ramp, constant, and drop phases of target force, the increase in magnetic stimulation-induced finger forces changes positively correlated with the number of fingers involved in the force tracking task. The magnetic stimulation-induced force changes from the index finger were less than the combination of the index and middle fingers or all four fingers under the corresponding target force, and the force changes from the combination of the index and middle fingers were less than all four fingers, Le., index finger 〈 index and middle fingers 〈 four fingers. CONCLUSION: Different neuromuscular mechanisms could be involved in finger force production for different finger combination patterns. Results from the present study suggested that independent motor neurons regulated individual finger force production.
文摘目的:研究镜像神经元康复策略(Mirror Neuron System,MNS)联合经颅磁刺激(Transcranial Magnetic Stimulation,TMS)对卒中后神经与功能康复的作用。方法:选取2019年1月至2023年6月某部队康复中心收治的198例卒中后遗留有运动功能障碍患者,采用随机数字表法分为三组,各66例。三组均给予常规康复指导,磁刺激组给予TMS治疗,镜像组给予MNS治疗,联合组给予TMS+MNS治疗。比较三组干预前、干预2周后、干预4周后神经功能(NIHSS)、上下肢运动功能(FMA)、日常生活能力(ADL)、平衡能力(BBS)、上肢与下肢肌张力(MAS)、健患侧步长差、患侧负重时间百分比及语言功能。结果:联合组干预2周、4周后NIHSS评分低于磁刺激组、镜像组,差异具有统计学意义(P<0.05),磁刺激组、镜像组组间比较,差异无统计学意义(P>0.05);联合组干预2周、4周后FMA-上肢、FMA-下肢评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后ADL评分、BBS评分高于磁刺激组、镜像组,且镜像组高于磁刺激组,差异具有统计学意义(P<0.05);联合组干预4周后上肢和下肢MAS分级0~1级患者占比高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05);联合组干预2周、4周后健患侧步长差低于磁刺激组、镜像组,患侧负重时间百分比高于磁刺激组、镜像组,且镜像组变化幅度大于磁刺激组,差异具有统计学意义(P<0.05);联合组干预2周、4周后语言功能中阅读理解、复述、流畅度、命名评分高于磁刺激组、镜像组,且磁刺激组高于镜像组,差异具有统计学意义(P<0.05)。结论:MNS联合TMS能促进卒中后神经与功能康复,有利于改善患者日常生活能力,且二者各有优势,互相补充,联合治疗效果显著,值得临床推广。
文摘帕金森病(Parkinson disease,PD)患者多数会出现言语功能障碍,严重影响生活质量。近年重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)在治疗PD患者言语障碍的临床实践中取得了新的进展。研究结果提示,将rTMS作用于初级运动皮质(primary motor cortex,M1)的口面部区域和颞上回(superior temporal gyrus,STG)可能会有效地改善PD患者的言语功能,现有研究未见报道有由rTMS引起的严重不良反应。rTMS治疗PD患者言语障碍的机制可能与rTMS可以调节言语相关大脑皮质(如M1和STG)的兴奋性和功能连接程度有关。总结来说,rTMS在PD言语障碍的治疗中取得了良好的效果,但目前研究的数量较少,未来还需要更多大规模和大样本量的随机对照试验来进一步验证和支持其效果。
文摘脑卒中是一种高发病率的急性脑血管疾病,常伴随肢体运动功能障碍的后遗症。经颅磁刺激(transcranial magnetic stimulation,TMS)作为一种非侵入式的脑刺激方法,大量临床实验证明其对卒中后运动功能障碍有明显的康复作用,但背后的神经康复机制仍不明确,需要更多的研究和探索。本文从TMS在运动功能评估、干预和康复预测模型的建立等方面入手,梳理、总结了近年来TMS在脑卒中运动康复领域的发展进程和研究现状,以期为后续研究提供参考。