Clinical Observation Of Repeated Transcranial Magnetic Stimulation Combined With Delexin In The Treatment Of Post-stroke Depressio

Objective To evaluate the clinical efficacy and Application of repetitive transcranial magnetic stimulation(r TMS)combined with Deanxit in the treatment of post stroke depression(PSD).Methods 145 patients with PSD were enrolled,and randomly divided into the combined group(n=50),the r TMS group(n=46)and the Deanxit group(n=49)by random number grouping method.139 patients completed the study including 48 patients in combination group,43 patients in r TMS group,and 48 patients in Deanxit group.The Deanxit group was treated with Deanxit alone,1 tablet / time,2 times / d for 8 weeks;the r TMS group was treated with high-frequency r TMS for 2 weeks;the combination group was treated with high-frequency r TMS combined with Deanxit.The general information survey scale was used to collect the general information of the research subjects.Blood samples were taken before treatment,2 weeks and 8weeks after treatment,Serum BDNF,5-hydroxytryptamine(5-HT)levels were measured by ELISA method,serum neuropeptide Y(NPY),corticotropin-releasing factor(CRF)were detected by radioimmunoassay methods,motor evoked potentials(MEP)were detected at the same time.Patient Health Questionaire-9(PHQ-9)was used for depression evaluation,cognitive function was assessed using the Montreal Cognitive Assessment(Mo CA).The Barthel index was used to evaluate the activities of daily living(ADL),and the SCL-90 was used to evaluate neuropsychological symptoms.Data analysis was performed using SPSS19.0 software.Results:(1)no significant differences were present in the distribution of age,gender,BMI,cultural level,onset location,baseline PHQ9 score,and baseline Mo CA score in the combination group,r TMS group,and Deanxit group(P> 0.05).(2)The serum levels of BNDF,5-HT,NPY and CRF in different groups were significantly different at 2 and 8 weeks after treatment(P <0.05).Serum BNDF and5-HT levels of combined group were significantly higher than those in the r TMS group and Deanxit group 2 weeks after treatment,and serum levels of BNDF,5-HT and NPY in combination group were significantly higher than those in the r TMS group and Deanxit group 8 weeks after treatment(P <0.05).(3)The MEP amplitude of patients in different groups increased significantly after treatment,and the MEP latency decreased significantly(P <0.05).The upper limb MEP amplitude results at 8th week: combination group> r TMS group> Deanxit group,and the MEP latency of the combination group was significantly lower than that of the r TMS group and Deanxit group at 8th week(P <0.05).(4)The results of the retest of PHQ9 scores 8 weeks after treatment showed that the scores of the combined group,r TMS group and Deanxit group were 7.4 ± 2.8,9.3± 2.1 and 10.2 ± 4.8,respectively.The results of two-way analysis of variance showed that there was a significant difference in the change trend of PHQ9 scores(P <0.05),of which combination group was significantly lower than the repetitive transcranial magnetic stimulation group and Deanxit group(P <0.05).(5)The evaluation results of the Mo CA scale showed that the median scores of the combination group,r TMS group,and Deanxit group were 24.0(21.0,27.0),23.0(19.0,26.0),and 22.0(19.0,25.0)8 weeks after the start of treatment(P <0.05).The combination group had significantly higher scores in delayed recall,visual space/execution,and abstraction than the r TMS group and Deanxit group(P <0.05).(6)The Barthel index scores of combination group,rTMS group,and Deanxit group were 72.5 ± 20.6,66.7 ± 18.4 and 63.9 ± 17.3 8 weeks after the treatment.There was a significant difference in the change trend of the Barthel index scores(P<0.05),the combination group was more than Deanxit group(P <0.05).(7)The SCL-90 evaluation of the Symptom Self-Assessment Scale showed that there was significant difference in anxiety,depression,somatization,obsessive-compulsive symptoms,interpersonal sensitivity,and psychotic changes in different groups(P<0.05)The anxiety,depression,somatization,obsessive-compulsive symptoms,and interpersonal sensitivity scores in the combination group were significantly higher than those in the repetitive transcranial magnetic stimulation group and Deanxit group(P <0.05).Conclusions(1)High-frequency rTMS combined with Deanxit can significantly increase the expression of neurotrophic factors and 5-HT in patients with PSD,and regulate the HPA axis.(2)The effect of high-frequency r TMS combined with Deanxit in improvement of depressive symptoms,cognitive function,activities of daily living and neuropsychological symptoms was significantly better than high-frequency r TMS or Deanxit alone,which is of great value in PSD treatment.