Yeung Jacky T, Young Isabella M, Doyen Stephane, Teo Charles, Sughrue Michael E
Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, AUS.
Research, Omniscient Neurotechnology, Sydney, AUS.
Cureus. 2021 Oct 28;13(10):e19105. doi: 10.7759/cureus.19105. eCollection 2021 Oct.
Repetitive transcranial magnetic stimulation (rTMS) is a promising approach for post-stroke rehabilitation but there lacks a rationale strategy to plan, execute, and monitor treatment. We present a case of targeted rTMS using the Omniscient Infinitome software to devise targets for treatment in a post-stroke patient and describe the functional connectomic changes after treatment. A 19-year-old female with no medical history presented 19 months after suffering a left middle cerebral artery (MCA) superior division ischemic stroke, resulting in language impairment and diminished right upper extremity motor function. She underwent a resting-state MRI (rsMRI) with tractography and images were processed using the Omniscient Infinitome software. Analysis using the anomaly detection within the software enabled us to identify three targets for rTMS (left area 1, left area 45, and right area SFL). These areas were treated with 25 sessions of intermittent Theta Burst Stimulation (iTBS) over five days at 80% of motor threshold concomitantly with targeted physical therapy and speech therapy. At five months follow-up, her language and right upper extremity functions significantly improved. Her connectomic analysis revealed substantial neural changes, including normalization of the sensorimotor network, substantially thicker callosal fiber bundle connecting the two hemispheres, and increased cortical recruitment in her language network. We present the first description of robust connectomic alterations in a post-stroke patient following targeted rTMS treatment. Further studies on the use of rTMS with an emphasis on functional connectomics are warranted.
重复经颅磁刺激（rTMS）是一种很有前景的中风后康复方法，但缺乏用于规划、实施和监测治疗的合理策略。我们报告了一例使用全知无限软件进行靶向rTMS的病例，该软件用于为一名中风后患者制定治疗靶点，并描述治疗后的功能连接组学变化。一名19岁无病史女性，在左大脑中动脉（MCA）上部分支缺血性中风19个月后出现语言障碍和右上肢运动功能减退。她接受了静息态MRI（rsMRI）及纤维束成像检查，并使用全知无限软件对图像进行处理。通过软件内的异常检测分析，我们确定了三个rTMS靶点（左侧1区、左侧45区和右侧SFL区）。在五天内，对这些区域进行了25次间歇性θ波爆发刺激（iTBS），刺激强度为运动阈值的80%，同时进行针对性的物理治疗和言语治疗。在五个月的随访中，她的语言和右上肢功能显著改善。她的连接组学分析显示出大量神经变化，包括感觉运动网络的正常化、连接两个半球的胼胝体纤维束明显增粗，以及语言网络中皮质募集增加。我们首次描述了中风后患者接受靶向rTMS治疗后连接组学的显著改变。有必要进一步开展侧重于功能连接组学的rTMS应用研究。
