Analysis of the Effect of Limb Rehabilitation Therapy Combined with Transcranial Magnetic Stimulation Therapy on Muscle Activity in Patients with Upper Limb Dysfunction After Cerebral Infarction

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.

Effect of Acupuncture Cooperated with Low-frequency Repetitive Transcranial Magnetic Stimulation on Chronic Insomnia： A Randomized Clinical Trial

The effect of acupuncture cooperated with low-frequency repetitive transcranial magnetic stimulation （rTMS） on chronic insomnia was explored. Seventy-eight patients with chronic insomnia were randomly allocated into two groups： treatment group and control group. In the treatment group, the patients received acupuncture combined with rTMS treatment, and those in the control group were given acupuncture cooperated with sham rTMS treatment, 3 days per week for 4 weeks. Before and after treatment, the primary outcomes including the scores on Insomnia Severity Index （ISI） and Pittsburgh Sleep Quality Index （PSQI） and the secondary outcomes including total sleep time （TST）, sleep onset latency （SOL）, wake after sleep onset （WASO）, sleep efficiency （SE%） recorded by sleeping diary and actigraphy were observed in both groups. Seventy-five participants finished the study （38 in treatment group and 37 in control group respectively）. After treatment, the scores in the two groups were improved significantly, more significantly in the treatment group than in the control group. It can be inferred that acupuncture cooperated with rTMS can effectively improve sleep quality, enhance the quality of life of patients and has less side effects.

Effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and quality of life

Objective:To investigate the clinical effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and its impact on quality of life.Methods:60 elderly patients with dysphagia caused by acute cerebral infarction were randomly divided into rTMS group and control group,30 cases in each group.Both groups received routine drug therapy and swallowing function training.rTMS group was additionally treated by ultra-low frequency(10mHZ)repetitive transcranial magnetic stimulation for 14 days.The changes of NIHSS score andADL score and NSE serum level and Wa Tian drinking water experiment and Fujishima Ichiro dysphagia scale score and SWAL-QOL score and SF-36 score were observed between the two groups before and after treatment.The clinical effect was evaluated by Wa Tian drinking water experiment.Results:After treatment,The clinical effective rate in rTMS group was significantly higher compared with that in the control group(P<0.05),NIHSS score and serum NSE level were significantly lower compared with the control group(P<0.05),ADL score and Fujishima Ichiro dysphagia score and SWAL-QOL score and SF-36 scores were significantly higher compared with the control group(P<0.05).After treatment,SF-36 total score(or SWAL-QOL Score)was negatively correlated with NSE serum level and NIHSS score,which was positively correlated with ADL score and Fujishima Ichiro dysphagia scale score score.Conclusion:Ultra-low frequency rTMS therapy can reduce NSE level,effectively improve dysphagia in elderly patients with acute cerebral infarction and significantly improve the elderly patients'life quality.

Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis?

Low-frequency repetitive transcranial magnetic stimulation（LF-r TMS） to the contralesional hemisphere and intensive occupational therapy（i OT） have been shown to contribute to a significant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-r TMS and i OT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient＇s Trail-Making Test part B（TMT-B） performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-five patients received 11 sessions of LF-r TMS to the contralesional hemisphere and 2 sessions of i OT per day over 15 successive days. Patients with right- and left-sided hemiparesis demonstrated significant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a significant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. The results indicate the possibility that LF-r TMS to the contralesional hemisphere combined with i OT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

Morita Therapy Combined with Transcranial Magnetic Stimulation in the Treatment of Postpartum Depression in Primiparas and its Effect on Prolactin

Objective:To explore the treatment of Morita therapy combined with transcranial magnetic stimulation in postpartum depression of primipara and its effect on prolactin.Method:From May 2018 to November 2019,92 cases of postpartum depression and postpartum women who were treated in our hospital were randomly divided into 2 groups,46 cases each.The control group was treated with transcranial magnetic stimulator,and the observation group was treated with Morita therapy on the basis of the control group.Both groups were treated continuously for 6 weeks.The degree of depression and prolactin levels of the two groups was observed.Results:After 6 weeks of treatment,the HAMD scores of the two groups were lower than before the treatment,and the observation group was the lowest.The prolactin levels of the two groups were higher than before the treatment,and the observation group was the highest.The difference was statistically significant(P<0.05).Conclusion:Morita therapy combined with transcranial magnetic stimulation can effectively improve the postpartum depression of primiparas,increase the level of prolactin,and have a good clinical effect.

A Clinical Study:Therapeutic Effects of Repetitive Transcranial Magnetic Stimulation and Cognitive Behavioral Therapy on Cognitive Impairment in Alcohol-Dependent Patients

Objective To observe the effects of repetitive transcranial magnetic stimulation(rTMS)and cognitive behavioral therapy(CBT)on cognitive function in alcohol-dependent patients.Methods Data from 285 alcohol-dependent patients were collected from Mudanjiang Medical University and Sun Yat-sen Memorial Hospital at Sun Yat-sen University between 2019 and 2021.The patients were divided into groups depending on alcohol abstinence and non-abstinence.There were 43 patients in the alcohol consumption(AC)group.The patients in the abstinence group were randomly assigned to treatment regimens with different combinations of rTMS and CBT using the Elton system.There were 49 patients in the TB+C0 group,36 in the TB+C1 group,44 in the TL+C0 group,36 in the TL+C1 group,37 in the TR+C0 group,and 40 in the TR+C1 group.Cognitive function was assessed by using the Montreal Cognitive Assessment Scale(MoCA).Results The proportion of patients with cognitive impairment in the AC group at 24 weeks was higher than that at baseline(P<0.05),whereas the proportion of cognitive impairment in the other groups did not differ significantly over time.The percentage of patients with cognitive impairment at 24 weeks was 52.3%in the TL+C0 group and 47.2%in the TL+C1 group,which was significantly lower than that in the AC group(P<0.05).MoCA scores at different time points in the AC group were significantly higher than those in the TB+C0,TL+C0,TL+C1,TR+C0,and TR+C1 groups,respectively.MoCA scores were significantly higher at 12 weeks compared with the baseline in the TB+C0,TL+C0,TL+C1,TR+C0,and TR+C1 groups(P<0.05),and similar changes were observed at 24 weeks.The MoCA scores in the TL+C1 and TL+C0 groups were higher than those in the TR+C0 group at 12 weeks after the intervention(P<0.05).Furthermore,MoCA scores in each of the TB+C1,TL+C1,TL+C0,TR+C1,and TR+C0 groups were higher than those in the AC group at 24 weeks(P<0.05).Conclusion Alcohol consumption impairs cognitive function,as evidenced by a significantly higher proportion of cognitive impairment after 24 weeks of non-abstinence.Most of the tested treatment regimens improved cognitive function.High frequency rTMS of the left dorsolateral prefrontal cortex(DLPFC)was associated with a greater improvement in cognitive function than that of the right DLPFC in alcohol-dependent patients at 12 weeks of abstinence.There does not appear to be a therapeutic advantage of CBT for cognitive impairment in alcohol-dependent patients.Screening for impaired cognitive function should be seriously considered for patients who engage in heavy drinking,and measures should be taken to reduce the risk of dementia induced by alcohol dependence.

Effects of different frequencies of repetitive transcranial magnetic stimulation on the recovery of upper limb motor dysfunction in patients with subacute cerebral infarction

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.

Clinical application of repetitive transcranial magnetic stimulation for post-traumatic stress disorder:A literature review

The efficacy of traditional treatment for post-traumatic stress disorder(PTSD)is still unsatisfactory.Repetitive transcranial magnetic stimulation(rTMS)has been widely used in the treatment of various types of mental disorders,including PTSD.Although rTMS has been demonstrated to be effective in many cases,there are still arguments regarding its mechanism and protocol.This review aims to summarize the origin,development,principle,and future direction of rTMS and introduce this neuro-stimulation therapy to relevant clinicians.

Therapeutic Application of High-Frequency rTMS Combined with Intensive Occupational Therapy for Pediatric Stroke Patients with Upper Limb Hemiparesis: A Case Series Study

Low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) applied to the non-lesional hemisphere is reported to significantly improve motor function of the affected upper limb in adult stroke patients with hemiparesis. For pediatric stroke patients, the beneficial effects of LF-rTMS have been already confirmed in a randomized controlled study. However, there is no report of therapeutic application of high-frequency rTMS (HF-rTMS) in this patient population. In this case series study, we introduced HF-rTMS combined with intensive occupational therapy (OT) in two pediatric hemiparetic patients. We studied two children (8- and 9-year-old boys, both right-handed) with post-stroke upper limb hemiparesis (chronic phase). Both patients underwent 22 treatment sessions of HF-rTMS/OT during 15-day hospitalization. The HF-rTMS was applied over the lesional motor cortex at a frequency of 10Hz for 15 minutes in each session. One session of intensive OT consisted of 30-min one-to-one training and 30-min self-exercise. Motor function of the affected upper limb was serially evaluated with Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Simple Test for Evaluating hand Function (STEF), and Ten-second Test. Neither of the patients showed any adverse effects. Both patients showed improvement of motor function in the affected upper limb and were able to use the affected upper limb in some activities of daily living. In the two post-stroke pediatric patients, HF-rTMS/OT was safe and improved upper limb muscle function. Confirmation of these effects in a larger population is needed.

Modified constraint-induced movement therapy enhances cortical plasticity in a rat model of traumatic brain injury:a resting-state functional MRI study

Modified constraint-induced movement therapy(mCIMT)has shown beneficial effects on motor function improvement after brain injury,but the exact mechanism remains unclear.In this study,amplitude of low frequency fluctuation(ALFF)metrics measured by resting-state functional magnetic resonance imaging was obtained to investigate the efficacy and mechanism of mCIMT in a control co rtical impact(CCI)rat model simulating traumatic brain injury.At 3 days after control co rtical impact model establishment,we found that the mean ALFF(mALFF)signals were decreased in the left motor cortex,somatosensory co rtex,insula cortex and the right motor co rtex,and were increased in the right corpus callosum.After 3 weeks of an 8-hour daily mClMT treatment,the mALFF values were significantly increased in the bilateral hemispheres compared with those at 3 days postoperatively.The mALFF signal valu es of left corpus callosum,left somatosensory cortex,right medial prefro ntal cortex,right motor co rtex,left postero dorsal hippocampus,left motor cortex,right corpus callosum,and right somatosensory cortex were increased in the mCIMT group compared with the control cortical impact group.Finally,we identified brain regions with significantly decreased mALFF valu es at 3 days postoperatively.Pearson correlation coefficients with the right forelimb sliding score indicated that the improvement in motor function of the affected upper limb was associated with an increase in mALFF values in these brain regions.Our findings suggest that functional co rtical plasticity changes after brain injury,and that mCIMT is an effective method to improve affected upper limb motor function by promoting bilateral hemispheric co rtical remodeling.mALFF values correlate with behavio ral changes and can potentially be used as biomarkers to assess dynamic cortical plasticity after traumatic brain injury.

高频重复经颅磁刺激治疗帕金森病认知功能障碍患者的临床效果

目的探究对帕金森病认知功能障碍患者使用高频重复经颅磁刺激治疗的临床效果。方法选取82例帕金森病认知功能障碍患者,均为郑州人民医院2022年1月至2023年5月收入,按随机数表法分为对照组与研究组,各41例。以左前额叶背外侧皮质为刺激区域,对照组41例患者使用高频重复经颅磁刺激(25 Hz)假性刺激治疗,研究组41例患者使用高频重复经颅磁刺激(25 Hz)真性刺激治疗。将两组患者临床治疗前后的认知障碍水平、P300变化及心理水平进行比较。结果研究组与对照组患者在治疗前蒙特利尔认知(MoCA)评分差异无统计学意义(P>0.05)。研究组患者治疗1个月、3个月后MoCA评分高于对照组患者,差异均有统计学意义(P<0.05)。治疗前研究组和对照组P300波幅与潜伏期差异无统计学意义(P>0.05)。治疗后研究组P300波幅明显升高,潜伏期降低,与对照组相比差异具有统计学意义(P<0.05)。治疗前两组患者汉密尔顿焦虑评分(HAMA)与汉密尔顿抑郁(HAMD)评分差异无统计学意义(P>0.05)。治疗后与对照组相比,研究组HAMA与HAMD评分下降,差异均有统计学意义(P<0.05)。结论高频重复经颅磁刺激是一种有效的治疗帕金森病认知功能障碍的方法,通过调控特定脑区的神经活动,改善患者认知功能水平,同时改善患者心理水平。

高频重复经颅磁刺激联合富马酸喹硫平对改善双相障碍Ⅱ型抑郁发作疗效和认知功能的临床研究

目的探讨高频重复经颅磁刺激(rTMS)与富马酸喹硫平联合治疗对双相障碍Ⅱ型抑郁发作的疗效、认知功能及安全性的影响。方法选择2022年5月—2023年10月本院收治的40例双相障碍Ⅱ型抑郁发作患者作为研究对象,随机数表法将患者分为研究组和对照组两组,每组各20例。两组在为期4周的治疗期间,研究组采用高频重复经颅磁刺激联合富马酸喹硫平治疗,对照组采用伪刺激联合富马酸喹硫平治疗。治疗前和治疗第1、2、3、4周末使用汉密尔顿抑郁评定量表(HMAD-24)评估临床疗效,使用韦克斯勒成人记忆量表第四版中文版(WNS-IV)、韦克斯勒成人智力量表(WAIS)、威斯康辛卡片分类测验(WCST)评估认知功能,并记录治疗中不良事件。结果治疗4周后,两组的总显效率差异无统计学意义(P>0.05)。研究组在第1、2周末的HMAD-24评分明显低于对照组,显示早期优势(P<0.05)。然而,治疗4周后,两组在认知功能测试(如理解记忆、再认等)方面无统计学差异(P>0.05)。同时,两组在治疗期间的不良反应发生率相近,无统计学差异(P>0.05)。这表明,尽管联合疗法在早期表现出较好疗效,但长期对认知功能的改善并不明显,且安全性相当。结论与单纯仅使用富马酸喹硫平治疗比较,高频rTMS联合富马酸喹硫平治疗在双相障碍Ⅱ型抑郁发作在治疗前期可较快改善患者抑郁症状,但在治疗4周后对于提升临床疗效及改善认知功能方面未能显现出明显优势。

推拿康复联合低频重复经颅磁刺激对脑卒中偏瘫患者脑血流动力学及肌张力的影响

目的探讨推拿康复联合低频重复经颅磁刺激对脑卒中偏瘫患者脑血流动力学及肌张力的影响。方法研究对象为2021-06—2023-06复旦大学附属华山医院、上海市第三康复医院收治的脑卒中偏瘫患者112例,依据随机数字法分为观察组和对照组,各56例。对照组采取低频重复经颅磁刺激治疗,观察组在此基础上采取推拿康复治疗。比较2组患者治疗前后血流动力学指标[双侧大脑动脉血流平均流速(Vm)、血流最大峰值(Vs)以及血管阻力指数(RI)]、上肢肌张力等级变化情况,以及肢体功能、生活能力评分,并统计2组临床疗效。结果观察组治疗总有效率83.93%(47/56),明显高于对照组的64.29%(36/56),差异有统计学意义(P<0.05)。观察组治疗后Vm、Vs明显高于对照组,RI明显低于对照组,差异有统计学意义(P<0.05)。观察组治疗后改良Ashworth痉挛量表评级0级、Ⅰ级的占比为60.71%(34/54),明显高于对照组的42.86%(24/56),差异有统计学意义(P<0.05)。观察组治疗后Fugl-Meyer运动功能评定量表评分、Barthel指数均明显高于对照组,差异有统计学意义(P<0.05)。结论推拿康复联合低频重复经颅磁刺激治疗脑卒中偏瘫,能够有效改善患者脑血流动力学及肌张力亢进,有助于肢体功能及生活能力的恢复,具有较好的疗效。

重复经颅磁刺激联合体外冲击波治疗在脑卒中偏瘫患者中的应用效果

目的探讨在脑卒中偏瘫患者中采取重复经颅磁刺激(rTMS)联合体外冲击波治疗(ESWT)的作用。方法选取2021年1月至2023年12月九江市第一人民医院收治的100例脑卒中偏瘫患者作为研究对象,采用随机数字表法分为对照组和观察组,每组各50例。对照组采取ESWT干预,观察组在对照组的基础上采取rTMS干预,两组患者均持续干预观察4周。比较两组患者上肢痉挛状态、上肢运动功能、日常生活活动能力以及生活质量。结果干预前,两组上肢痉李状态、上肢运动功能、日常生活活动能力以及生活质量比较,差异无统计学意义(P>0.05)。干预后,观察组改良Ashworth挛评定量表(MAS)评分低于对照组,简化Fugl-Meyer运动功能评分法-上肢部分(FMA-UE)评分、改良Barthel指数(MBI)评分高于对照组,差异有统计学意义(P<0.05);干预后,观察组生存质量简表(QOL-BREF)中周围环境、社会关系、心理健康等维度评分均高于对照组,差异有统计学意义(P<0.05)。结论rTMS联合ESWT干预可改善脑卒中偏瘫患者上肢挛状态和上肢运动功能,有效提升患者日常生活活动能力,进而改善患者生活质量。

高频经颅磁刺激联合康复训练对脑卒中后吞咽障碍患者表面肌电图的影响

目的探讨高频经颅磁刺激(TMS)联合康复训练对脑卒中后吞咽障碍患者表面肌电图(sEMG)的影响。方法选取南京医科大学附属淮安第一医院神经内科2022年1月~2023年1月收治的脑卒中后吞咽障碍患者100例,采用随机数表法分为观察组和对照组,各50例。对照组给予常规吞咽康复训练,观察组在对照组基础上联合高频TMS治疗。比较两组患者临床疗效;评估两组患者洼田饮水试验等级以及标准吞咽功能评定量表(SSA)和吞咽障碍严重度评估量表(DOSS)评分;检测两组患者舌骨上、下肌群最大波幅值及吞咽时程;评估两组患者吞咽生存质量问卷(SWAL-QOL)评分。结果观察组总有效率96.00%显著高于对照组82.00%,差异有统计学意义(χ2=5.005,P<0.05);治疗后,两组患者洼水试验评估等级改善显著优于治疗前,且观察组改善显著优于对照组,差异有统计学意义(Z=4.157,P<0.05)。治疗后,两组患者SSA评分低于治疗前,DOSS评分高于治疗前,且观察组SSA评分低于对照组,DOSS评分高于对照组[(23.15±3.51)分vs.(28.21±4.59)分、(6.11±0.78)分vs.(5.16±0.89)分],差异有统计学意义(t=6.192、5.676,P<0.05)。治疗后,两组患者舌骨上、下肌群最大波幅值均显著高于治疗前,吞咽时程短于治疗前,且观察组治疗后舌骨上、下肌群最大波幅值均显著高于对照组,吞咽时程短于对照组[(752.46±94.56)μg vs.(605.45±65.48)μg、(732.12±82.15)μg vs.(594.56±55.89)μg、(1.83±0.42)s vs.(2.15±0.62)s、(1.87±0.41)s vs.(2.32±0.54)s],差异有统计学意义(t=9.038、9.790、3.022、4.693,P<0.05);两组治疗后SWAL-QOL评分显著高于治疗前,且观察组显著高于对照组[(185.45±14.41)分vs.(164.45±15.21)分],差异有统计学意义(t=26.258,P<0.05)。结论高频振幅值增加可促进脑卒中后吞咽障碍患者大脑神经元兴奋性增加,致使其引起更多神经元发放行动电位,促进神经元之间的连接和信息传递,不仅可有效改善患者临床症状以及吞咽功能,还能改善其舌骨上、下肌群最大波幅值、吞咽时程以及生活质量。

浮针法联合经颅磁刺激治疗脑卒中后肩手综合征Ⅰ期的临床疗效及安全性评价

目的评估浮针联合经颅磁刺激用于脑卒中恢复期肩手综合征(PSHS)治疗的临床效果。方法选择收治的80例脑卒中恢复期肩手综合征患者作为研究对象,随机分为试验组(40例)、对照组(40例)。两组均给予脑卒中常规西医内科综合治疗治疗。试验组40例使用浮针法联合经颅磁刺激;对照组40例给予常规康复治疗。借助肩手综合征评估量表(SHSS)、简式McGill疼痛量表(SF-MPQ)与运动功能量表(FMA-UE)来评估患者干预前后上肢的损伤程度、运动功能、疼痛症状、日常生活能力。并使用χ^(2)检验和t检验对患者的一般资料以及疗效指标进行比较。结果治疗后与治疗前组内比较,两组SHSS评分、McGill量表评分均下降(P<0.05);组间治疗后比较,SHSS评分、McGill量表评分差异有统计学意义(P<0.05)。干预后和未干预时进行组内对比,两组FMA-UE评分以及改良Barthel量表评分皆显著提高(P<0.05);组间治疗后比较,在这两项评分上差异有统计学意义(P<0.05)。干预期间,两组皆没有出现明显的不良反应。结论浮针法联合经颅磁刺激疗法可明显改善PSHS。

醒脑开窍针刺法联合经颅磁刺激对缺血性卒中后恢复期抑郁状态的影响

目的 观察醒脑开窍针刺法联合经颅磁刺激对缺血性卒中后患者恢复期抑郁状态的影响。方法 将80例符合纳入标准的患者随机分为综合组(40例,中止1例)和西药组(40例,脱落2例)。西药组予口服盐酸度洛西汀肠溶片治疗,综合组在西药组口服药物基础上予醒脑开窍针刺法联合经颅磁刺激治疗。分别于治疗前后观察患者美国国立卫生院卒中量表(National Institutes of Health stroke scale,NIHSS)、改良Barthel指数(modified Barthel index,MBI)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)和匹茨堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)的评分变化,以及血清同型半胱氨酸(homocysteine,Hcy)、中性粒细胞/淋巴细胞的比值(neutrophil/lymphocyte ratio,NLR)、5-羟色胺(5-hydroxytryptamine,5-HT)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)的水平变化。观察两组治疗前后经颅多普勒超声颅内大血管[大脑前动脉(anterior cerebral artery,ACA)、大脑中动脉(middle cerebral artery,MCA)、大脑后动脉(posterior cerebral artery,PCA)及椎动脉(basilar artery,BA)]血流速度的变化。结果 治疗后,两组患者NIHSS、MBI、HAMD和PSQI评分以及血清Hcy、NLR、5-HT和BDNF水平均较治疗前改善(P<0.05),且综合组上述指标均优于西药组(P<0.05)。治疗后,两组ACA、MCA、PCA和BA血流速度均优于治疗前(P<0.05),且综合组上述血管血流速度均优于西药组(P<0.05)。结论 在药物治疗基础上,醒脑开窍针刺法联合经颅磁刺激治疗卒中后患者恢复期抑郁状态的临床疗效优于单一口服西药治疗,可减轻患者的抑郁程度,改善睡眠质量,提高肢体功能和日常生活能力,加快脑血管血流速度,改善血清Hcy、NLR、5-HT和BDNF的水平。

电针联合低频经颅超声刺激对创伤性脑损伤大鼠脑电信号的影响

背景:创伤性脑损伤是由头部受到撞击、打击而导致大脑正常功能被破坏的疾病,目前需要寻找有效治疗方式和客观指标,帮助医生判别损伤状况及恢复患者脑功能。目的:探究电针联合低频经颅超声刺激对创伤性脑损伤大鼠脑电信号的影响。方法:将40只6周龄SPF级雄性SD大鼠随机分为假手术组、模型组、电针组、低频经颅超声刺激组和联合组(n=8),后4组采用Feeney自由落体法造模,假手术组只开骨窗而不打击。各干预组均于造模后1 d开始实施干预,电针组进行电针干预,低频经颅超声刺激组进行低频经颅超声刺激干预,联合组进行两者联合干预,共干预7 d。造模后8 h,用改良神经功能缺损评分评定大鼠神经功能缺损情况;干预7 d后观察大鼠Y迷宫自发轮流行为百分比,而后采集脑电信号,利用快速傅里叶变换分解出α、β、θ和δ波段,计算各频段振荡幅值、能量占比百分比以及Lempel-Ziv复杂度、样本熵。结果与结论:①造模后8 h,模型组、电针组、低频经颅超声刺激组和联合组的改良神经功能缺损评分显著高于假手术组(P<0.05);②造模后第7天,模型组的α波、δ波频带振荡幅值、δ波能量占比百分比显著高于假手术组(P<0.05),自发轮流行为百分比、α波、β波能量占比百分比、Lempel-Ziv复杂度、样本熵显著低于假手术组(P<0.05);③与模型组比较,联合组的α波、δ波频带振荡幅值显著下降(P<0.05),电针组、低频经颅超声刺激组、联合组的α波、β波频带能量占比百分比显著升高(P<0.05),δ波能量占比百分比显著下降(P<0.05);④与电针组和低频经颅超声刺激组相比,联合组的δ波能量占比百分比显著降低(P<0.05),自发轮流行为百分比、α波、β波能量占比百分比、Lempel-Zi复杂度、样本熵显著升高(P<0.05);⑤结果显示,创伤性脑损伤大鼠出现脑电信号异常,而电针联合低频经颅超声刺激干预后可以改善大鼠脑电信号的异常情况,提示脑电频域特征和非线性特征可用来评估创伤性脑损伤情况。

基于Notch1通路探讨不同频率重复经颅磁刺激改善大脑中动脉闭塞大鼠学习记忆能力的机制

目的:观察不同频率重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对大脑中动脉闭塞(middle cerebral artery occlusion,MCAO)大鼠学习记忆能力的影响及探讨其作用机制。方法:将造模成功的MCAO模型大鼠随机均分为模型组、低频组、高频组,同时另设假手术组,每组12只。低频组和高频组均予采用CCY-I型经颅磁刺激仪刺激,2次/日,连续14d;低频组:1Hz,部位:大鼠颅部左侧前额叶;高频组频率:10Hz,部位:大鼠颅部右侧前额叶。模型组和假手术组不予治疗仅同等情况下抓取束缚后归笼。神经行为学评分在术后第1天和第14天进行;水迷宫测试于术后3—7天进行;TTC染色、PCR及Western blot检测关键基因(Notch1、Hes1、Hes5)的mRNA及蛋白表达均在术后第14天干预结束后进行。结果:(1)神经功能缺损评分:与模型组相比,干预治疗14d后,高频组、低频组两组神经功能评分出现降低的情况(P<0.05),模型组与高频组之间无明显差异(P>0.05)。(2)Morris水迷宫实验:定向航行实验平均逃避潜伏期:低频组、高频组、假手术组均相比于同组前一天缩短,具有显著性差异(P<0.05);每天逃避潜伏期比较,高频组较模型组短,低频组较高频组短,具有显著性差异(P<0.05)。空间探索实验穿越平台次数:低频组和假手术组比较、高频组和模型组比较无显著性差异(P>0.05);高频组、模型组次数比假手术组少,低频组比模型组、高频组次数多,具有显著性差异(P<0.05)。(3)TTC染色:低频组、高频组梗死灶面积小于模型组。(4)PCR检测及Western Blot检测:高频组、低频组与模型组相比,Notch1、Hes1、Hes5的mRNA及蛋白表达量升高,具有显著性差异(P<0.05);低频组与高频组相比,Notch1、Hes1、Hes5的mRNA及蛋白表达无显著性差异(P>0.05)。结论:高/低频rTMS均能改善MCAO大鼠的学习记忆能力,且可能都予激活提高海马组织中的Notch1通路表达,提高海马突触可塑性有关。

头针配合低频重复经颅磁刺激治疗痉挛性脑性瘫痪疗效观察

目的基于脑电频谱技术,观察头针配合低频重复经颅磁刺激治疗痉挛性脑性瘫痪的临床疗效。方法将90例痉挛性脑性瘫痪患者和20例健康儿童分为病例组和正常组,通过采集静息态脑电信号比较各频谱(δ、θ、α、β、γ)密度。再将病例组随机分为A组、B组和C组,每组30例。在接受常规康复训练的基础上,A组采用头针治疗,B组采用低频重复经颅磁刺激治疗,C组采用头针配合低频重复经颅磁刺激治疗。观察3组治疗前后粗大运动功能测试量表-88(gross motor function measure-88,GMFM-88)评分(D区、E区)、Gesell发育诊断量表各项评分、颅内椎基底节动脉血流状态各项指标[左侧椎动脉(left vertebral artery,LVA)、右侧椎动脉(right vertebral,RLA)、基底动脉(basilar artery,BA)平均流速]、各项炎症因子[血清白细胞介素-6(interleukin-6,IL-6)、白细胞介素-33(interleukin-33,IL-33)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)]水平及脑电信号各频谱密度的变化情况,比较3组临床疗效。结果C组治疗后D区、E区GMFM-88评分及Gesell发育诊断量表各项评分较同组治疗前显著上升,LVA、RLA、BA平均流速显著加快,各项炎症因子水平显著降低,差异均具有统计学意义(P<0.05)。C组治疗后D区、E区GMFM-88评分及Gesell发育诊断量表各项评分均明显高于A组和B组,LVA、RLA、BA平均流速明显快于A组和B组,各项炎症因子水平明显低于A组和B组,差异均具有统计学意义(P<0.05)。病例组治疗前脑电信号δ、θ频谱密度明显高于正常组(P<0.05);3组治疗后脑电信号δ、θ频谱密度均较同组治疗前显著降低(P<0.05)。C组总有效率为83.3%,明显高于A组的63.3%和B组的56.7%,差异均具有统计学意义(P<0.05)。结论在常规康复训练的基础上,头针配合低频重复经颅磁刺激治疗痉挛性脑性瘫痪疗效确切,能改善患者运动功能和认知功能,其机制主要与该方法能下调炎症因子表达、调节颅内椎基底节动脉血流状态有关。