The Effects Of Repetitive Transcranial Magnetic Stimulation On Upper Limb Hemiparesis In Stroke Patients

Objective:1 The aim of this study was to investigate the effective stimulation pattern of rTMS on motor dysfunction,especially the upper limb motor function recovery in stroke patients by Meta analysis and clinical trials.2 To investigate the effects of low-frequency repetitive transcranial magnetic stimulation(rTMS)combined with task-oriented training on the recovery of the upper limb motor function of the stroke patients.3 To compare the effects of LF-,LF-HF and sham-rTMS on the upper limb motor function in the early phase post stroke.The above researches provided the experimental basis for the optimization of stroke rehabilitation strategy.Methods:1 Review Manager software(RevMan 5.1)recommended by the Cochrane collaboration was used to evaluate and analyze the previous studies of repetitive transcranial magnetic stimulation in the rehabilitation of stroke patients with motor dysfunction related literatures.Articles retrieval from Chinese and foreign language data.Quantitative analysis was based on the combined effect.Meta analysis was performed to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation in the rehabilitation of stroke patients.2 The patients with unilateral upper limb dysfunction after stroke in our hospital,were selected and randomized two groups: 1Hz rTMS group or sham-rTMS group.The patients received 4 weeks(once per day,6 days per week)of 1Hz rTMS or sham-rTMS over the contralesional cortex followed by task-oriented training.Before test,at the end of intervention and 3 months after the ending of intervention,Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Wolf Motor Function Test(WMFT)and movement-evoked potentials(MEP)were detected and compared.3 Sixty-two patients were randomly assigned to three groups: LF-rTMS group(1 Hz rTMS to the contralesional hemisphere),and LF-HF rTMS group(1 Hz rTMS to the contralesional hemisphere followed by 10 Hz rTMS to the lesional hemisphere)and the sham-rTMS group(sham-rTMS to the bilateral cerebral hemisphere).The patients received the same conventional rehabilitation accompanied with sessions of rTMS for 15 consecutive days.The upper limb motor function was evaluated using the Fugl-Meyer Assessment(FMA)and the Wolf Motor Function Test(WMFT)before the first session,after the last session,and at 3 months after the last session.Results:1 Meta analysis showed that rTMS has promoting effects on motor function recovery after stroke.rTMS can be used as a supplementary scheme of the conventional rehabilitation therapy.According to the results,no significant difference was found between high frequency and low frequency repetitive transcranial magnetic stimulation.In some cases,the high frequency stimulation mode seemed to be more effective.2 In Experiment one,at the end of the intervention and three month later,FMA score and WMFT score were increased in both groups,significantly higher in the rTMS group.Only two patients in rTMS group induced MEP in the ipsilesional cortex.In control group,no significant difference was found in the latency time or central conduction time of contralesional MEP.In rTMS group,a little longer latency time was found in contralesional MEP although without significance.It suggested that task-oriented training promotes the upper limb motor function recovery.When combined with low-frequency rTMS over contralesional cortex,it may induce more improvement even without significant change in MEP.3 In Experiment two,all patients finished the study without any pathologic symptoms.Three groups exhibited improvement in terms of the FMA score and the log WMFT time at the end of the treatment and 3 months later.Better improvement was found in the LF-HF rTMS group than in the LF-rTMS and sham groups.Conclusion:1 High frequency and low frequency r TMS can promote the recovery of motor function in stroke patients.A small number of RCT studies have shown that the combined use of the HF-LF rTMS model may be a more effective mode of magnetic stimulation.2 Low-frequency rTMS over the contralesional cortex combining task-oriented training protocol could better promote the upper limb motor recovery after stroke,worthy to recommend its clinical use.3 Both LF-and LF-HF rTMS were effective in promoting upper limb motor recovery in patients with acute stroke.Combining HF-and LF-rTMS is safe and more beneficial for motor improvement than the use of LF-rTMS alone.