Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.
Office of Radiation Technology, Keio University Hospital, Tokyo, Japan.
Int J Neurosci. 2023 Jul;133(7):705-713. doi: 10.1080/00207454.2021.1968858. Epub 2021 Sep 15.
To evaluate activity changes associated with the intervention of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) after stroke using functional magnetic resonance (fMRI). Seventy stroke patients were scanned while performing finger tapping tasks twice, before and 12 days after the intervention. Recovery of motor functions assessed using Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) for upper extremity at each time point. An fMRI analysis was performed, and a region of interest (ROI) analysis was conducted using percentage signal changes (% SC) to determine the magnitude of activation. FMA and WMFT-FAS were significantly increased from pre-intervention to post-intervention. Intervention related activations were seen in the ipsilesional premotor cortex (PMC) and primary motor cortex (M1), thalamo-cortico regions with the paretic hand movements. With the unaffected hand movements, significant clusters in the contralesional primary somatosensory cortex (S1), superior parietal cortex, and bilateral cerebellum were observed. The ROI-based analysis revealed that ipsilesional M1, contralesional PMC, and supplementary motor area (SMA) showed significantly higher results with the paretic hand movements, a trend toward a significant decrease in the contralesional S1 with the unaffected hand movements from the pre-intervention to post-intervention. Our findings suggest that gains in motor functions produced by the intervention of rTMS and intensive OT in hemiparesis stroke patients may be associated with the ipsilesional hemisphere and contralesional hemisphere as well. Identifying rTMS and OT intervention based on cortical patterns may help to implement rTMS in motor rehabilitation after stroke.Supplementary data for this article is available online at https://doi.org/10.1080/00207454.2021.1968858 .
评估低频重复经颅磁刺激（rTMS）和强化作业治疗（OT）干预后卒中患者的活动变化，采用功能磁共振（fMRI）。70 例卒中患者在干预前和干预后 12 天进行两次手指敲击任务扫描。在每个时间点使用 Fugl-Meyer 评估（FMA）和 Wolf 运动功能测试-功能能力量表（WMFT-FAS）评估上肢运动功能的恢复情况。进行 fMRI 分析，并使用百分比信号变化（%SC）进行感兴趣区（ROI）分析，以确定激活的幅度。FMA 和 WMFT-FAS 均从干预前到干预后显著增加。与干预相关的激活出现在同侧运动前皮质（PMC）和初级运动皮质（M1）、与瘫痪手运动的丘脑皮质区域。对于非瘫痪手运动，观察到对侧初级体感皮质（S1）、顶叶上皮质和双侧小脑的显著簇。基于 ROI 的分析表明，同侧 M1、对侧 PMC 和辅助运动区（SMA）在瘫痪手运动时显示出更高的结果，从干预前到干预后，非瘫痪手运动时对侧 S1 的结果呈显著下降趋势。我们的研究结果表明，rTMS 和强化 OT 干预对半侧麻痹卒中患者运动功能的提高可能与同侧和对侧半球有关。根据皮质模式识别 rTMS 和 OT 干预可能有助于实施卒中后的运动康复中的 rTMS。本文的补充数据可在 https://doi.org/10.1080/00207454.2021.1968858 在线获取。
