| Objective:To observe the clinical efficacy of repetitive transcranial magnetic stimulation in the treatment of post-stroke depression and to explore its mechanism.Method:A total of 67 patients with PSD who were admitted to the Rehabilitation medicine department of the Second hospital of Jilin University from December 2017 to February 2019,who met the diagnostic criteria of post-stroke depression(PSD)in the consensus of Chinese experts on the clinical practice of PSD in 2016 and PHQ9≥5 scores.PSD patients were randomly divided into the following six groups: Group A:blank control group;Group B: low frequency rTMS stimulation on the right side of the dorsolateral prefrontal cortex(DLPFC)group;Group C: drug + low-frequency rTMS stimulation on right DLPFC group;Group D: high frequency rTMS stimulation on left DLPFC group;Group E: drug + high-frequency rTMS stimulation on left DLPFC group;Group F: drug treatment group.Each group was given basic rehabilitation treatment,but the above patients were not treated with rTMS in motor dysfunction.All patients were treated for 2 weeks,before and after the treatment,extracted the elbow venous blood 5 ml on an fasting state,centrifuged at 3500 r/min,10 minutes,the separation of serum saved in 1.5 ml EP tube at-20℃,the Brain Derived Neurotrophic Factor(BDNF)in peripheral blood serum was determined by double-antibody entrainment enzyme-linked immunosorbent assay(ELISA).The mini-mental State Examination(MMSE),PHQ9 scale and improved Barthel index were assessed before and after the treatment.And affected upper limb motor evoked potentials(MEP)were tested,recording its amplitude and latency before and after the treatment.All the data in the process of experiment adopt SPSS22.0 statistical software for statistical analysis,using mean + /-standard deviation(`x±s)to describe the normal distribution of measurement data.Before and after treatment in the group used paired sample t test.The treatment group and the blank control group after treatment by using singlefactor ANOVA analysis,LSD test,all with P < 0.05 for the difference was statistically significant.PHQ9 and Barthel index scales were used to evaluate the clinical efficacy of rTMS in the treatment of PSD,and MMSE evaluation results,BDNF expression level and MEP conduction were tested to explore the mechanism of rTMS in the treatment of PSD.Result:1.Analysis of the general data of the patients enrolled: there was no difference in the gender,age and disease composition of the patients(P>0.05);2.After 2 weeks of treatment,the PHQ9,ADL,and MMSE scales were scored before and after treatment in each group.The MEP latency and amplitude of the upper limbs of the affected side,and the serum BDNF concentration of the peripheral blood were analyzed by paired samples.The results showed:(1)The PHQ9 score after treatment was lower than that before treatment,which was statistically significant in Group B(Low Frequency on right DLPFC),Group C(drug + low frequency on right DLPFC),Group D(high frequency on left DLPFC group),Group E(drug + high frequency on left DLPFC group),Group F(drug treatment group)(P<0.05).There was no significant difference before and after treatment in Group A(blank control group)(P>0.05).(2)After treatment,the ADL score,MMSE score,serum BDNF concentration,and MEP amplitude of the upper limb of the affected side were higher than those before treatment,which was statistically significant in Group B、C、D、E(P<0.05).There was no significant difference before and after treatment in Group A and F(P>0.05).(3)After treatment,the MEP latency of the upper limbs was shorter than that before the treatment,which was statistically significant in Group B、C、D、E(P<0.05).There was no significant difference before and after treatment in Group A and F(P>0.05).3.After 2 weeks of treatment,the PHQ9,ADL,MMSE scores,the MEP latency and amplitude of the upper limbs,the peripheral blood serum BDNF concentration were analyzed by single factor ANOVA,LSD test between the treatment groups(Group B、C、D、E、F)and the blank control group(Group A).The results show:(1)After treatment,the PHQ9 scores of Group B and Group D were lower than those of Group A,which was statistically significant(P<0.05).The scores of PHQ9 inGroup C、E、 F were not significantly different from those in Group A(P>0.05).(2)After treatment,ADL score,MMSE score,serum BDNF concentration,and MEP amplitude of upper limbs in the affected group in Group B、C、D、E were significantly higher than those in Group A,which was statistically significant(P<0.05).There was no significant difference between Group F and Group A after treatment(P>0.05).(3)After treatment,MEP amplitude of upper limbs in the affected group in Group D were significantly higher than those in Group A,which was statistically significant(P<0.05).There was no significant difference between GroupB、C、E、F and Group A after treatment(P>0.05).(4)The MEP latency of the upper limbs in Group D、E was shorter than that of the Group A,which was statistically significant(P<0.05).There was no significant difference between Group B、C、F and Group A after treatment(P>0.05).Conclusion:1.rTMS treatment can reduce the PHQ9 score of PSD patients and improve their mood.2.rTMS treatment can improve MMSE score and improve cognitive ability.3.rTMS treatment can improve ADL score and daily living ability.4.rTMS treatment can increase the serum BDNF concentration in peripheral blood and promote nerve regeneration.5.rTMS treatment can increase the MEP amplitude of upper limb on the affected side,shorten the MEP latency of upper limb on the affected side,improve cortical excitability,and further promote the recovery of motor function. |
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