The Effect Of 5Hz High-frequency Repetitive Transcranial Magnetic Stimulation On The Recovery Of Motor Function In The Patients With Acute Ischemic Stroke

Objective: To detect the effect of 5Hz high-frequency repetitive transcranial magnetic stimulation (rTMS) on the recovery of motor function in the patients after acute ischemic stroke.Methods: A total of 30 ischemic stroke patients were prospectively studied in our hospital from March 2008 to December 2009.Thirty initial stroke with hemiparalysis were randomly divided into three groups: rTMS of ipsilateral M1 group (rTMS+ pharmacotherapy) (n=10), rTMS of contralateral M1 group (rTMS + pharmacotherapy) (n=10),and the control group (sham rTMS + pharmacotherapy)(n=10).Stimulate parameters are 5Hz,the intensity was 80% (3.5T),1 00 pulses,15 sessions, Sequence interval 2 seconds, duration was 10 days. The three groups were assessed by motor function scores(NIHSS,ADL scores) and corticospinal excitability(MEP latency period and CMCT )before and after ten and forty days of treatment. Some patients were selected randomly in each group,the NAA, Cr and the ratio of NAA/Cr were recorded and evaluated by MRS at the first and the fortieth day.Results: Before treatment the scores of NIHSS,ADL and MEP latency period and CMCT have no statistical significance in the three groups(P>0.05). In each group after treatment than those in pre-clinical functional score improved (P<0.01). Compared with the other two groups,the change of score of NIHSS decreased significantly in the patients treated with ipsilateral M1 stimulation at the tenth and fortieth day, contrary to the score of ADL(P<0.01). There were no significant changes of motor function scores (NIHSS,ADL scores) between the patients who received contralateral M1 stimulation and the control treatment group at the tenth day (P>0.05). The changes of ADL scores of the contralateral M1 group were more significant than the control treatment group at the fortieth day (P<0.01). The changes of MEP latency and CMCT of the patients who received ipsilateral M1 stimulation were more significant (P<0.05)than the baseline at the tenth and fortieth day.The changes of CMCT of the patients who received ipsilateral M1 stimulation were more significant than the control treatment group at the tenth and fortieth day(P<0.01).There were no significant changes of MEP latency and CMCT between the patients who received contralateral M1 stimulation and the control treatment group at the the tenth and fortieth day. Correlation analysis showed that NIHSS score and MEP latency and CMCT were significantly positively correlated, contrary to the score of ADL(P<0.01).Compared with other two group, the ratio of NAA/Cr increased significantly of ipsilateral group.Conclusions: The excitability of cortex was raised by the stimulation of 5HZ suprathreshold rTMS over ipsilateral M1 in the acute ischemic stroke patients. 5HZ suprathreshold rTMS over ipsilateral M1 can improve the motor function and cerebral metabolism in the patients with acute ischemic stroke. The same effects were not seen in patients who received contralateral M1 stimulation.