Effect Of Diffrent Frequency RTMS On Rehabilitation Of Motor Function In Patients With Cerebral Infarction

[Background]As China’s aging process and the improvement of living standards, cerebral infarction has become a common、multiple disease in the old people.The main methods of treatment include the drug therapy of acute and rehabilitation in the recovery phase. During the acute phase of drug treatment including:thrombolysis, anti-platelet aggregation, anticoagulation. stabilize the plaque, vegetative nerve etc, drug therapy can reduce the mortality, Save the patient’s life, to alleviate further aggravating illness, but for cerebral infarction have been caused by the death of brain tissue and functional defects such as motor dysfunctions Swallowing dysfunction、 Speech dysfunction, need of autoantibodies in patients with functional exercise, now, there is still a lack of efficient, safe rehabilitation measures, give a heavy psychological burden and economic pressure to the family and society enormous.So find a effective treatment measures, promote patient recovery of movement function has been paid more and more attentionRepetitive transcranial magnetic stimulation is a new neural electrophysiological techniques based on transcranial magnetic stimulation developed.It can influence local and distant cortical function. Realization of function of the cortex region reconstruction, influence the excitability of cerebral cortex. Improve regional cerebral blood flow and a variety of neurotransmitters and gene expression level.The action principle of transcranial magnetic stimulation is through a time-varying magnetic field induced electric field. Specific for a fast current pulses through the stimulation coil, produce a Strong magnetic field generated. The magnetic field passes through the skull, causing adjacent nerve tissues secondary current. Induce the local generation of neuronal depolarization. In order to produce physiological effect. The biological effects can last up to a period of time after cessation of stimulation.Bilateral hemisphere brain cortex in the normal state of the contralateral cortex has inhibitory effect,After cerebral infarction, Ipsilateral cerebral cortex excitability decreased. Inhibition on the contralateral cerebral hemisphere reduced. Cause of bilateral cerebral hemisphere excitatory imbalance. Influence patients rehabilitation of motor function.. The study of low frequency repetitive transcranial magnetic stimulation can reduce the stimulation of local blood flow and metabolism, and for the patients to be high frequency repetitive transcranial magnetic stimulation is the opposite. Can make local blood flow and metabolism increased the level of stimulation..Low frequency repetitive transcranial magnetic stimulation by reducing blood flow and metabolism level of the contralateral reduced excitability, and make it on ipsilateral inhibition reduces. In order to improve the motor function of patients with cerebral infarction.[objective]To compare the effects of high and low frequencies of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation of motor function in patients with cerebral infarction. [Methods]From October2010to June2011,60patients with cerebral infarction undergoing treatment in our department were randomly assigned into3even groups. In addition to conventional medication and functional training for all patients, group A were given high frequency (3Hz) rTMS once per day and10minutes per time for14days, group B low frequency (1Hz) rTMS and group C sham stimulation in the same manner. Three groups of patients were consistent with cerebral infarction treated with rTMS inclusion criteria.。The inclusion criteria for the patients:(1)First onset, and after15days of onset.(2)the cerebral infarction of internal carotid artery system;(3)confirmed by CT or MRI;(4)blood pressure controlled smooth, blood pressure controlled under150/90mm Hg;(5) Conscious, check the body cooperation,GOS>8. Exclusion criteria:(1) Condition worse, the emergence of new or large area cerebral infarction;(2) Having a history of epilepsy, family history of epilepsy and serious heart, lung and other important organs function failure;(3) Severe cognitive and communication disorders and not with the treatment;(4) In vivo cardiac pacemaker stent, metal implants;(5) Various types of cerebral hemorrhage;(6) With severe cervical lesions include cervical instability.high frequency rTMS group: male11, female9cases,The average age (60.1±3.5) years old,Course of disease2.9-21.1monthes;Low frequency rTMS group:male11, female9cases,The average age (59.8±3.7) years old,Course of disease2.5-22.5monthes; Sham stimulation group:male12, female8cases,The average age (58.9±2.9) years old,Course of disease1.0-20.8monthes; Comparison of characteristics of three groups had no significant difference (P>0.05).the data of them is comparable.In the conventional drug therapy and functional training for the treatment of the same condition. Three groups of patients were given high frequency, low frequency, sham stimulation of repetitive transcranial magnetic stimulation, to observe its clinical effect. [Treatment theraphy]Choose YYD CYY-1type stimulation apparatus, Maximum stimulation intensity of up to3T, Coil diameter of12.5cm, High frequency stimulation group: Coil placed horizontally stimulation sites affected side first somatosensory cortex motor area, the stimulus intensity for80%MT. stimulation frequency is3Hz, each time give600stimulations, once per day. Low frequency group:Coil placed horizontally stimulation sites contralateral first somatosensory cortex motor area, the stimulus intensity for80%MT, stimulation frequency is3Hz, each time give600stimulations, once per day. Sham stimulation group:Vertical coil placed stimulation sites, the stimulus intensity for80%MT, stimulation frequency is3Hz, each time give600stimulations, once per day. Both give them14days therapy. Give every patient FMA、BI、MEP、 CMCT cetermination before the first theraphy and after the last therephy. Measure the blood pressure,pulse before and after treatment.Ask about history, to ensure that patients without contraindications to treatment, give a brief introduction of principle of treatment and possible reactions during the treatment. Patients completed treatment after a break of twenty minutes, and they can leave if they don’t have any problem.Most of them don’t have any problem.but some of them felt headache, stimulation skin numbness, facial muscle is numb and other related adverse reaction[Evaluation of curative effect]1Simple Fugl-Meyer motor function assessment2Barthel index score3Motor evoked potential latency4Central motor conduction time[Statistical method]Using SPSS13.0statistical software to experimental results for statistical analysis.data using the mean-SD (+s) said, the same group before and after treatment were compared using paired sample t test, mean compared with single factor analysis of variance, a further two two compared with SNK-q method. With P <0.05indicates that the difference was statistically significant[Result]1Simple Fugl-Meyer motor function assessmentThe FMA score is a evaluation used to evaluate the hemiplegia patients’ somatic function refinement and quantification developed by Brunnstrom6grade classification, the evaluation of the project is more, can be a better response in patients with somatic motor function.Before treatment, FMA of three groups compared no significant difference (P>0.05), in three groups after the treatment, compared with before treatment showed statistically significant differences (P<0.05). And high frequency stimulation group compared with sham stimulation group showed statistically significant differences (P <0.05). Low frequency stimulation group compared with sham stimulation group showed statistically significant differences (P<0.05).High frequency stimulation group compared with low frequency stimulation group shows no statistical significance (P>0.05).Means that high frequency rTMS and low frequency rTMS has the curative effect, and no significant difference between the two treatment.2Barthel index scoreThe Barthel index is used to assessment the patient’s ability to live independently, functional damage situation developed metric, this score can react with the patients’ daily life abilityBefore treatment, BI of three groups compared no significant difference (P>0.05), in three groups after the treatment, compared with before treatment showed statistically significant differences (P<0.05). And high frequency stimulation group compared with sham stimulation group showed statistically significant differences (P <0.05). Low frequency stimulation group compared with sham stimulation group showed statistically significant differences(P<0.05).High frequency stimulation group compared with low frequency stimulation group shows no statistical significance (P>0.05).Means that high frequency rTMS and low frequency rTMS has the curative effect, and no significant difference between the two treatment.3Motor evoked potential latencyMotor evoked potential latency:The latency is from stimulus onset to motor response time, In MEP is the easiest and most reliable index determination.MEP is stimulate the motor cortex and in the contralateral target muscle to record muscle complex potential, to check motor nerve from the cortex to the muscle transfern Conduction pathways of the overall synchronization and integrity. Record five better wave latency values,take the average.Before treatment, MEP of three groups compared no significant difference (P>0.05), in three groups after the treatment, compared with before treatment showed statistically significant differences (P<0.05). And high frequency stimulation group compared with sham stimulation group showed statistically significant differences (P <0.05). Low frequency stimulation group compared with sham stimulation group showed statistically significant differences (P<0.05).High frequency stimulation group compared with low frequency stimulation group shows no statistical significance (P>0.05).Means that high frequency rTMS and low frequency rTMS has the curative effect, and no significant difference between the two treatment.4Central motor conduction timeCentral motor conduction time:Spinal cord stimulation of adjacent nerve root also can lead to target muscle action, Motor evoked potential latency time minus the peripheral nerve conduction time, obtain Central motor conduction time. Central motor conduction time is the conduction time from the cerebral cortex to the spinal cord anterior horn motor neurons, mainly reflect on motor neurons and spinal cord anterior horn cell function. Peripheral motor conduction time by electric or magnetic stimulation of spinal nerve root measurement of F wave latency. Corticospinal tract demyelination、degenerative、Ischemic changes and spinal cord diseases will lead to the CMCT extension, and usually earlier than clinical symptoms.Before treatment, BI of three groups compared no significant difference(P>0.05), in three groups after the treatment, compared with before treatment showed statistically significant differences (P<0.05). And high frequency stimulation group compared with sham stimulation group showed statistically significant differences (P <0.05). Low frequency stimulation group compared with sham stimulation group showed statistically significant differences (P<0.05).High frequency stimulation group compared with low frequency stimulation group shows no statistical significance (P>0.05).Means that high frequency rTMS and low frequency rTMS has the curative effect, and no significant difference between the two treatment.[Conclusion]Repetitive transcranial magnetic stimulation is an effective and painless, noninvasive, nondestructive improve motor function of cerebral infarction patients rehabilitation therapy.Both high frequency rTMS and low frequency rTMS can promote motor functional recovery for patients with cerebral infarction, and their effects are not significantly significance.