| Objective: To observe the efficacy and safety of different frequencies of repetitive transcranial magnetic stimulation(rTMS)combined with escitalopram in patients with post stroke depression(PSD),and to detect changes in serum brain-derived neurotrophic factor(BDNF)levels.Methods: Patients of PSD were enrolled prospectively in the department of rehabilitation from January 2019 to October 2020,and were divided into 4 groups according to the random number table: high frequency group A(20 Hz rTMS+escitalopram),high frequency group B(5 Hz rTMS+escitalopram),low frequency group(1 Hz rTMS+escitalopram)and control group(sham stimulation +escitalopram).Patients of the 4 groups received routine rehabilitation training and took escitalopram.On this basis,the high frequency group A received 20 Hz rTMS treatment,the high frequency group B received 5 Hz rTMS treatment,and the low frequency group received 1 Hz rTMS treatment.The control group was given rTMS sham stimulation,1 time/day,5 times/week,for 4 consecutive weeks.The Hamilton Depression Scale-17(HAMD-17),Pittsburgh Sleep Quality Index(PSQI),Montreal Cognitive Assessment Scale(MoCA)and Modified Barthel Index(MBI)were used to assess the depression of patients before treatment and 4 weeks after treatment.Degree,sleep quality,cognitive function and ability of daily living activities.And detect the peripheral serum BDNF levels before and after treatment,and record the occurrence of adverse events during the treatment.Results: A total of 92 patients with PSD who met the enrollment criteria were enrolled,including 58 males and 34 females.During the study,1 patient in the high frequency group B had femoral neck fracture,and 1 patient in the control group had colon cancer withdrew from the study.In the end,a total of 90 patients completed the study and were included in the analysis.Compared with before treatment,the HAMD-17 scores of the control group,high frequency A group,high frequency B group and low frequency group were significantly reduced after 4 weeks of treatment,and the difference was statistically significant(P<0.05).Compared with the control group,the HAMD-17 scores of patients in the high-frequency A,high-frequency B and low-frequency groups were significantly reduced after 4 weeks of treatment;compared with the high-frequency B and low-frequency groups,the patients in the high-frequency A group were treated for4 weeks the HAMD-17 score was significantly reduced,and the differences were statistically significant(P<0.05).Compared with before treatment,the PSQI scores of the control group,high frequency A group,high frequency B group and low frequency group were significantly reduced after 4 weeks of treatment,and the difference was statistically significant(P<0.05).Compared with the control group,the PSQI scores of the patients in the high-frequency A group,the high-frequency B group and the low-frequency group were significantly reduced after 4 weeks of treatment;compared with the high-frequency A group and the high-frequency B group,the PSQI scores of the patients in the low-frequency group were 4 weeks after treatment significantly reduced,the difference was statistically significant(P<0.05).Compared with before treatment,the MoCA scores of patients in the high-frequency A group increased significantly after 4 weeks of treatment,and the difference was statistically significant(P<0.05);the patients in the control group,the high-frequency B group and the low-frequency group had no MoCA scores after 4 weeks of treatment Significantly increased,the difference was not statistically significant(P>0.05).Compared with the control group,high-frequency B group and low-frequency group,the MoCA scores of patients in the high-frequency A group increased significantly after 4 weeks of treatment,and the difference was statistically significant(P<0.05).Compared with before treatment,the MBI scores of the control group,high frequency A group,high frequency B group and low frequency group were significantly increased after 4 weeks of treatment,and the difference was statistically significant(P<0.05).Compared with before treatment,the serum BDNF level of patients in the high frequency A group was significantly increased after 4 weeks of treatment,and the difference was statistically significant(P<0.05);the control group,the high frequency B group and the low frequency group were treated for 4 weeks of serum BDNF.The level did not increase significantly,and the difference was not statistically significant(P>0.05).Compared with the control group,the high-frequency B group and the low-frequency group,the serum BDNF level of the patients in the high-frequency A group increased significantly after 4 weeks of treatment,and the difference was statistically significant(P<0.05).In terms of adverse events,one patient in the high-frequency A group and one in the high-frequency group B each had a slight headache after the first day of treatment,which could be relieved after rest.No other adverse reactions were observed in the remaining patients.Conclusions: Different frequency rTMS treatment combined with escitalopram can improve the depression and sleep quality of patients with PSD,and improve the quality of life.Among them,the 1 Hz rTMS mode combined with escitalopram has a better effect in improving sleep quality;20 Hz rTMS mode combined with escitalopram has more advantages in improving depression and cognition,and the serum BDNF level of patients after treatment is higher than before treatment. |
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