| Objective: To observe the effects of low-frequency repetitive transcranial magnetic stimulation(LF-rTMS)combined with scalp acupuncture(SA)on dystonia in patients after ischemic stroke,and regional homogeneity(ReHo)algorithm of resting-state magnetic resonance technique(rs-f MRI)was used to explore the underpinning neuroimaging mechanisms regarding LF-TMS combined with SA improving dystonia changes of stroke patients.We aim to provide visual and clinical evidence that acupuncture-magnetic combination improves motor dysfunction following stroke.Methods: Seventy-one patients with ischemic stroke were recruited and randomly divided into an experimental group and a control group.The control group consisted of regular treatment and SA,while the protocol for the experimental group conducted LF-rTMS over the M1 region on the unaffected side of the brain based on that of the control group.Each session lasted 20 minutes,once a day for six consecutive sessions,over two weeks for a total of 12 sessions.Rs-f MRI scan and the Modified Ashworth Scale(MAS),Wolf Motor Function Test(Wolf),and the Modified Barthel Scale(MBI)were performed for two groups pre-and post-intervention.The following metrics were observed:(1)Changes in the behavioral parameters(MAS,Wolf and MBI)in the two groups before and after treatment;(2)Inter-and intra-group changes in MAS scales for subgroups before and after treatment;(3)Trend changes in index of assessment of curative effect of two groups;(4)Between-group and within-group ReHo values in two groups;(5)ReHo values of significantly different brain areas were extracted,partial correlation analysis of ReHo values of different brain areas and significant behavioral metrics was conducted with age as covariates.Results:1.Baseline results: There was no statistically significant difference between the experimental and control groups in terms of age,gender and duration of illness(p>0.05);there was no statistically significant difference on the MAS,Wolf and MBI in between-group comparison(p>0.05).2.Within-group efficacy analysis results: relative to the pre-treatment period,the upper limb MAS scores were significantly lower in the trial group(p<0.05)and there was no significant difference in the upper limb MAS scores in the control group(p>0.05);MBI scale and Wolf scale scores were significantly higher in both the trial and control groups(p < 0.05).In the MAS grade 1 and1+ subgroups,MAS scores were significantly lower in the test group relative to pre-treatment(p<0.05),while the MAS scores in the control group were not significantly different(p>0.05);There was no significant difference in the upper limb MAS scores in the remaining subgroups(p > 0.05).3.Between-group efficacy analysis results: There was no statistical difference in the MAS,Wolf,and MBI in between-group comparison(all ps>0.05).However,in the subgroup analysis,it was found that LF-rTMS combined with SA significantly could improve the muscle tone of upper limbs in subjects of MAS grade 1(p<0.01).Beside,in the trend analysis,it was found that LF-rTMS combined with SA significantly could improve the muscle tone of upper limbs(DID=0.30,p<0.01)compared to the control group.4.Between-group ReHo analysis:Relative to the control group,ReHo values were significantly higher in the right inferior cerebellum(Cerebelum＿7b＿R)in the experimental group(Alpha Sim corrected,Voxel P value <0.01,Cluster P value < 0.05).5.Within-group ReHo analysis: ReHo values in the left middle temporal gyrus,the right triangular part of inferior frontal gyrus,the right insula,the right middle frontal gyrus,the right precental gyrus,the right parahippocampal gyrus and the left Temporal pole: middle temporal gyrus was significantly lower relative to the preintervention in the experimental group(Alpha Sim corrected,Voxel P value < 0.01,Cluster P value < 0.05).There were no brain areas with different ReHo values before and after treatment in the control group.6.Correlation analysis between behavioral indicators and ReHo values: There was a negative correlation between the Wolf difference and the ReHo difference in the right inferior cerebellum in the experimental group(r=-0.814,P=0.014);In the control group,there was no significant correlation in any comparison(all ps > 0.05).Conclusion:1.The effect of two weeks of LF-rTMS combined with SA intervention based on conventional rehabilitation was comparable to that of SA in improving muscle tone,motor function,and daily living activities in patients with ischemic stroke.However,the acupuncture-magnetic combination can significantly improve upper limb spasticity in patients with MAS grade 1,and there were a significant tendency to improve upper limb spasticity in subject.2.Changes in the synchronization of neuronal activity in local brain regions such as the right inferior cerebellum after rTMS combined with SA intervention were associated with improvements in upper limb motor function and changes in self-care of daily living in stroke patients,respectively.The underlying neuroimaging mechanism responsible for the improvement of motor function in patients with ischemic stroke in the condition of the acupuncture-magnetic combination may be related to the modulation of local activity in motor-related brain regions including cerebellum. |
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