Chang Pang-Wei, Lu Chia-Feng, Chang Shin-Tsu, Tsai Po-Yi
Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.
Department of Biomedical Imaging and Radiological Sciences, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Neurol Ther. 2022 Mar;11(1):103-121. doi: 10.1007/s40120-021-00300-0. Epub 2021 Nov 13.
Although repetitive transcranial magnetic stimulation (rTMS) is efficacious for motor neuromodulation in stroke survivors, high interindividual variability for responsiveness remains a concern. Target probing on the skull using a proper brain-mapping technique may help overcome this challenge. This study assessed the feasibility of functional near-infrared spectroscopy (fNIRS) as a target navigator in rTMS treatment for motor facilitation in patients with stroke.
Fifty-one patients with stroke were enrolled in this randomized controlled study. The patients were assigned to three groups: fNIRS-guided rTMS treatment (fNIRS group, n = 20), motor evoked potential (MEP)-guided rTMS treatment (MEP group, n = 16), and sham (n = 15) group. Motor assessments, including Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and muscle strength, were conducted at baseline and after the 10-session rTMS treatment.
The fNIRS-guided hotspot (fNIRS-HS) was obtained for each patient, even those for whom the MEP-guided hotspot was undetectable. Both intervention groups exhibited significant improvements in muscle strength, FMA, and WMFT scores (P < 0.001) compared with the sham group. The fNIRS group achieved significantly greater improvement in elbow function (P = 0.001) than the MEP group.
fNIRS can be a reliable tool for hotspot navigation for motor neuromodulation in patients with stroke. With high sensitivity to cortical oxygenation changes, this navigation system achieved a superior outcome to the traditional MEP-based method in patients with stroke. fNIRS-based systems may also facilitate the integration of machine learning, thus enabling precision medicine for neuromodulation.
https://clinicaltrials.gov ; Unique identifier: NCT02006615.
尽管重复经颅磁刺激（rTMS）对中风幸存者的运动神经调节有效，但个体间反应性的高度变异性仍是一个问题。使用适当的脑图谱技术在颅骨上进行靶点探测可能有助于克服这一挑战。本研究评估了功能近红外光谱（fNIRS）作为rTMS治疗中风患者运动促进靶点导航仪的可行性。
51例中风患者纳入本随机对照研究。患者被分为三组：fNIRS引导的rTMS治疗组（fNIRS组，n = 20）、运动诱发电位（MEP）引导的rTMS治疗组（MEP组，n = 16）和假刺激组（n = 15）。在基线和10次rTMS治疗后进行运动评估，包括Fugl-Meyer评估（FMA）、Wolf运动功能测试（WMFT）和肌肉力量评估。
为每位患者获取了fNIRS引导的热点（fNIRS-HS），即使是那些MEP引导的热点无法检测到的患者。与假刺激组相比，两个干预组的肌肉力量、FMA和WMFT评分均有显著改善（P < 0.001）。fNIRS组在肘部功能方面的改善明显大于MEP组（P = 0.001）。
fNIRS可以作为中风患者运动神经调节热点导航的可靠工具。由于对皮层氧合变化具有高敏感性，该导航系统在中风患者中取得了优于传统基于MEP方法的结果。基于fNIRS的系统还可能促进机器学习的整合，从而实现神经调节的精准医疗。
