Study On The Brain Network Mechanism Of Low-frequency RTMS In The Treatment Of Spastic Hemiplegia After Stroke Based On Resting State FMRI

Objective: To investigate the brain effect mechanism of rTMS on motor function recovery in patients with spasmodic hemiplegia,we used resting state functional magnetic resonance imaging to observe the changes of the whole brain functional connectivity before and after the intervention of low frequency repeated transcranial magnetic stimulation(rTMS).Methods: Twenty patients with spastic hemiplegia after stroke were included and randomly divided into the rTMS treatment group(n = 10)and the conventional treatment group(n = 10).Patients in both groups received conventional physical therapy,and the rTMS group was additively treated with low-frequency rTMS for 8 weeks.Modified Ashworth Scale(MAS),Fugl-Meyer Upper Extrem Motion Scale(FMA-UE)and Modified Barthel Index(MBI)were evaluated before and after intervention,and resting state f MRI examination was performed.The regional of interest(ROI)based method was used to analyze the changes of functional connectivity in the whole brain in patients with post-stroke spasm.Results: 1.Compared with before treatment,at 8 weeks of treatment,FMA-UE and MBI scores of rTMS group and conventional treatment group were significantly increased(P <0.05),MAS scores of rTMS group were significantly decreased(P < 0.05),but MAS scores of conventional group were not significantly different(P > 0.05).2.Compared with the conventional group,FMA-UE and MBI scores in rTMS group were significantly increased(P< 0.05),and MAS scores were significantly decreased(P < 0.05)after 8 weeks of treatment.3.In rTMS group,the connection between seed point and whole brain function was enhanced before and after treatment.The specific performance was as follows: right anterior central gyrus and cerebellum,left posterior central gyrus and left cerebellum and precuneus,left auxiliary motor area and right cerebellum and left middle frontal gyrus,right auxiliary motor area and left superior frontal gyrus and right cerebellum,right thalamus and left anterior central gyrus,left auxiliary motor area and right superior frontal gyrus Gyrus,left putamen and right cerebellum.4.Compared with the conventional group,the connection between seed point and whole brain function was enhanced in the rTMS group,which was shown as: right central anterior gyrus and cerebellum,left auxiliary motor area and right superior frontal gyrus and right cerebellum,right caudate nucleus and left anterior wedge lobe,right thalamus and right superior lobule.Conclusion: 1.Low frequency repetitive transcranial magnetic stimulation can effectively relieve upper limb spasm in stroke patients,help improve motor function and improve daily activity ability.2.Low frequency rTMS can reduce the excitability of the contralateral hemisphere,promote functional remodeling not only by enhancing the functional connectivity in the motor network,but also enhance the functional connectivity in the remote brain regions,and accelerate the recovery of spastic function in stroke patients.