| Objectives: The clinical effects of low-frequency(1 Hz)and high-frequency(10 Hz)repetitive transcranial magnetic stimulation(rTMS)on limb motor function and serum levels of vascular endothelial growth factor(VEGF)and brain derived neurotrophic factor(BDNF)in patients with cerebral infarction hemiplegia were observed.The purpose of this study is to guide and provide a reference for the clinical application of rTMS and to find serum evaluation index that may reflect the clinical efficacy of rTMS.Methods: Patients with cerebral infarction hemiplegia who were admitted to the Department of Rehabilitation Medicine of the Second Affiliated Hospital of Hospital from March 2022 to January 2023 were recruited as study subjects according to the inclusion and exclusion criteria.All patients were randomly divided into three groups through a random number table method,namely the low-frequency group,the high-frequency group,and the sham stimulation group.Patients in all three groups underwent conventional medication and rehabilitation,followed by a 2-week rTMS or sham stimulation programme.Patients in the low-frequency group received the low-frequency rTMS with 1 Hz at in the primary motor cortex(M1)of the healthy hemisphere.Patients in the high-frequency group received the high-frequency rTMS with 10 Hz at the M1 of the affected hemisphere,and those in the sham-stimulation group received the sham stimulation at the M1 of the affected hemisphere.The serum VEGF and BDNF levels were measured before and after the treatment.The Fugl-Meyer motor recovery assessment(FMA),Wolf Motor Function Test(WMFT),Modified Barthel Index(MBI),Berg Balance Scale(BBS),The National Institute of Health Stroke Scale(NIHSS)and the Modified Ashworth Scale(MAS)were used to assess motor function in all patients.Results: 1.Forty-one patients with cerebral infarction hemiplegia were recruited as study subjects according to the inclusion and exclusion criteria.All patients were randomly divided into three groups,namely the low-frequency group(14),the high-frequency group(14),and the sham stimulation group(13).Prior to the treatment,the general data of the three groups were compared and the differences were not statistically significant(P>0.05);the differences in the total FMA score(including upper limb part and lower limb part),BBS score,WMFT score,MBI score,serum VEGF and BDNF levels of the three groups were not statistically significant(P>0.05).2.After 2 weeks of treatment,the FMA-UE score and the FMA-LE score increased significantly in both the low-frequency and high-frequency groups comparing to the pre-treatment values(P< 0.05);the pre-treatment and post-treatment difference in the sham-stimulation group was not statistically significant(P>0.05).After the treatment,there was no statistically significant difference in the FMA-UE scores among the three groups(P>0.05).When the results were compared,it was found that the FMA-LE scores in both the low-frequency and high-frequency groups were significantly higher than those in the sham-stimulation group(P<0.05),and the difference between the low-frequency and high-frequency groups was not statistically significant(P>0.05).3.The BBS scores,WMFT scores and MBI scores of patients in the three groups increased significantly after the treatment(P<0.05),and the NIHSS scores decreased comparing to the pre-treatment(P<0.05).The differences in BBS scores,WMFT scores,MBI scores and NIHSS scores after treatment were not statistically significant among the three groups(P>0.05).4.The differences in MAS scores among the three groups before and after treatment were not statistically significant(P>0.05)in inter-group and intra-group comparisons.5.The VEGF content increased significantly after treatment in the low-frequency group(P < 0.05),whereas the VEGF content decreased significantly after treatment in the sham-stimulation group(P < 0.05).There was no statistically significant difference between the pre-and post-treatment VEGF content in the high-frequency group(P > 0.05).After the treatment,the VEGF content in the low-frequency and high-frequency groups increased significantly comparing to the sham-stimulated group(P < 0.05).However,there was no statistically significant difference between the low-frequency and high-frequency groups(P > 0.05).6.The differences in the pre-and post-treatment BDNF levels in all three groups were not statistically significant(P > 0.05).After the treatment,the differences in BDNF levels among the three groups were not statistically significant(P > 0.05).7.There was a positive correlation between the increased BDNF content and the increased FMA-UE score(r=0.563,P<0.05)and increased WMFT score(r=0.643,P<0.05)after the treatment in the low-frequency rTMS group,and the difference was statistically significant.The difference between the increased VEGF content and the increased FMA-UE score(r=0.663,P<0.05)after the treatment in the high-frequency rTMS group was positively correlated and statistically significant.All patients showed a positive correlation between increased VEGF content and the increased FMA-UE score(r=0.407,P<0.05),FMA-LE score(r=0.392,P<0.05),WMFT score(r=0.473,P<0.05),MBI score(r=0.467,P<0.05)and BBS score(r=0.381,P<0.05)after the treatment,which are positively correlated and the differences were statistically significant.The difference between the increased BDNF content and the increased values of WMFT score(r=0.391,P<0.05)and MBI score(r=0.316,P<0.05)was positively correlated and statistically significant.8.Patients in this study who received rTMS or sham stimulation did not experience any serious adverse effects before,during or after the treatment.Conclusions: 1.Both the 1Hz low-frequency rTMS and the 10 Hz high-frequency rTMS have similar efficacy,which can promote the recovery and improvement of motor function in patients with cerebral infarction,and can promote the expression of serum VEGF.It is a safe and reliable approach with few adverse effects.2.Serum VEGF can be used as the potential serum evaluation index of motor function improvement for people being treated with rTMS after the cerebral infarction. |
PDF Full Text Request