The Prognosis Evaluation Of Motor Function Recovery And Therapeutic Trial By Transcranial Magnetic Stimulation In Patients With Acute Ischemic Stroke

PURPOSE: To investigate the prognosic evaluation of motor function recovery by transcranial magnetic stimulation in patients with acute ischemic stroke. METHODS: 37 patients with hemiparesis were studied in the first week and 90 days after ischemic stroke and scaled by NIHSS, BI and MAS. TMS (Medtronic R30) was performed at the same time, recording the MEP and SP in the thenar eminence muscles. The relevance rating of MEP, SP and clinical scales were analyzed. RESULTS: MEP and SP were significantly different in the affected hemisphere in patients compared with the unaffected hemisphere in 7 days after stroke. It was the same in the affected hemisphere in 7 days compared with those in 90 days. It had showed better motor function recovery in patients who were detected MEP and SP than those not. The SP provided information of motor function recovery and the state of physical spasm.CONCLUSIONS: MEP and SP obtained by TMS in patients with hemiparesis after acute ischemic stroke are useful early prognostic indicators of motor function recovery. SP can serve as a sensitive indicator of nerve damage in early assessment of patients.We can predict the occurrence of spasm by SP, which will have the significance in guiding the treatment.PURPOSE: To explore the role of low-repetitive transcranial magnetic stimulation (rTMS) on motor function recovery in patients with acute ischemic stroke. METHODS: We conducted a study of rTMS in the patients of stroke. 32 patients were randomly divided into 2 groups. Each one in treatment group received a subthreshold rTMS at the contralesional PM1 (0.5 Hz, 20 pulses in a sequence, 60 sequences one day, each sequence interval 5 seconds, 7days) applied with a figure-8 coil connected to a Medtronic R30 stimulator. And the patients were scaled by NIHSS, BI, MAS and Fugl-Meyer scale in 7 days and 90 days after stroke. RESULTS: NIHSS , MAS and Fugl-Meyer scale were significantly different in the affected hemisphere of patients received stimulation in comparison to those of the patients in control group in 90 days after stroke. When compared with the control group, rTMS reduced the threshold of motor evoked potentials and the SP duration in affected PM1. The SP of affected hemisphere in the treatment group patients was much shorter than that in the control group.CONCLUSIONS: rTMS improve motor function and decrease spasm condition in patients in the acute stage of ischemic stroke. Perhaps rTMS could decrease interhemispheric inhibition and balance the excitility of two hemispheres.PURPOSE: To study the role of rTMS on functional reorganization of brain regionsduring a motor task as measured by functional MRI in patients with acute ischemicstroke.METHODS: We recruited 12 patients who were in 7 days after their first stroke andreceived a subthreshold rTMS at the contralesional PMl applied with a figure-8 coilconnected to a Medtronic R30 stimulator. None of them had infarcts involving thehand region of the primary motor cortex. All subjects were scanned whilstperforming an isometric, dynamic visually paced handgrip task in day 7 and day 90after stroke. The degree and amplitude of task-related activation in PMl regions wereevaluated.RESULTS: There was no significant difference in degree of activation in thebilateral SMA in 7 days and 90 days after stroke, but which could be seen in theamplitude of activation in the bilateral PM1. We found that there were severalactivation patterns over the patients with severe lesion. The activated regions were 2or more in 90 days after stroke.CONCLUSIONS: We found that patients were more likely to have a tendency offocusing on ipsilateral PMl during the motor task after rTMS in day 90. Theactivation of brain areas transformed from contralesional to ipsilateral and localizedon the ipsilateral PM1. And the data suggested that patients have distinct changes inthe activation of the cerebellum. We supposd that rTMS would promote thefunctional organization after stroke which is good to rehabilitation...