Study On The Efficacy And Metabolomics Mechanism Of Closed-Loop Rehabilitation Therapy Based On Transcranial Direct Current Stimulation In Patients With Convalescent Cerebral Infarction

Objective The purpose of this study was to evaluate the effect of closed-loop rehabilitation based on transcranial direct current stimulation on motor function in convalescent patients with cerebral infarction,and to analyze its metabolomics mechanism by hydrogen proton magnetic resonance spectroscopy.The significance of this topic is to provide a new idea of treatment and metabonomic basis for the recovery of motor function in patients with convalescent cerebral infarction.Method The enrolled cerebral infarction patients were randomly divided into tDCS treatment group and sham control group in the part 1.On the basis of conventional rehabilitation therapy,the tDCS treatment group was given MOTOmed synchronous tDCS bilateral primary motor cortex M1 stimulation,with anode stimulation on the affected side and cathode stimulation on the healthy side,the stimulation intensity was 2m A,and the treatment time was20min per time(once daily).The course of treatment lasted for 10 days.Sham control group was treated with MOTOmed synchronous tDCS bilateral M1 zone stimulation.The electrode placement site and course were the same as those of the treatment group,but the treatment current was 0m A.The patients in the two groups were evaluated by Fugl-Meyer balance scale,Fugl-Meyer motor function scale and modified bathel index before and after treatment.The serum samples from tDCS group and sham control group were collected before and after treatment in part 2.~1H-NMR metabolomics was performed on serum samples using 600M nuclear magnetic resonance spectrometer.Potential differential metabolic markers before and after treatment were identified and metabolic pathways involved were analyzed through multivariate statistical analysis and database comparison.ResultPart 1:1.There was no significant difference between the two groups at baseline before treatment(P<0.05).2.Fugl-Meyer balance function evaluation:The balance function of both groups was significantly improved after treatment(P<0.05),and the improvement degree of balance function in tDCS group was more significant than that in sham control group..3.Fugl-Meyer upper limb motor function evaluation:The upper limb motor function of the two groups was significantly improved after treatment(P<0.05),but there was no significant difference in the improvement degree of upper limb function between the two groups(P>0.05).4.Fugl-Meyer hand motor function evaluation:There were differences between the two groups before and after treatment(P<0.05),but the improvement was less,and there was no significant difference in the upper limb function between the two groups after treatment(P<0.05),and the efficacy of tDCS on hand function needs to be further studied..5.Fugl-Meyer lower limb motor function evaluation:The lower limb function of the two groups was significantly improved after treatment(P<0.05),and the lower limb function of tDCS treatment group was better than that of sham treatment group.6.Modified Bathel index evaluation:The daily living activities of both groups improved after treatment(P<0.05),and the improvement degree of tDCS group was more significant than that of sham control group.Part 2:1.Analysis of metabolic markers before and after treatment in tDCS group:the contents of four biomarkers were up-regulated after treatment,namely ribose,thiocysteine,glycyl proline and gluconate,and the differences of metabolite contents before and after treatment were statistically significant(P<0.05).2.Analysis of differences in metabolic markers between the two groups after treatment:the contents of six metabolites in the tDCS group were higher than those in the sham control group,namely,glycine proline,niacin,taurine,mannitol,serine and hyperserine,with statistically significant differences(P<0.05).3.There was no statistically significant difference in metabolites between the two groups before treatment,and no statistically significant difference in metabolites within the sham control group before and after treatment(P>0.05).4.The enrichment results of metabolic pathways include pentose phosphate metabolic pathway,taurine and low taurine metabolic pathway,primary bile biosynthesis pathway.Conclusion1.The closed-loop rehabilitation therapy with synchronous tDCS central regulation and MOTOmed exercise training can improve the motor function of patients in the convalescent stage of cerebral infarction,and the therapeutic effect is more significant than that of single exercise training;The improvement of balance,proximal upper limb and lower limb motor function is obvious,but the efficacy of hand function remains to be further studied.Compared with sham control group,tDCS group had slightly higher ability of daily living activities,mainly in improving the balance and posture transfer ability related to gross motor function.2.The characteristic differences in the metabolomics of patients in the recovery stage of cerebral infarction treated by tDCS could be found by ~1H-NMR metabolomics testing:upregulation of potential metabolic markers such as ribose,thiocysteine,glycine proline,gluconate,niacin,taurine,serine,and hyperserine;It mainly involves three metabolic pathways:pentose phosphate metabolic pathway,taurine and low taurine metabolic pathway,primary bile acid bioanabolism pathway.These results indicate that tDSC can inhibit excitatory neurotoxicity and inflammatory reaction,reduce neuronal apoptosis,reduce peroxidation damage,improve atherosclerosis and improve cerebral blood circulation by regulating amino acid metabolism,glucose and lipid metabolism,nucleotide metabolism and energy metabolism.