Kim Jongwook, Cha Byoungwoo, Lee Doyoung, Kim Jong Moon, Kim MinYoung
Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea.
Rehabilitation and Regeneration Research Center, CHA University School of Medicine, Seongnam, South Korea.
Front Neurol. 2022 Jan 31;13:823108. doi: 10.3389/fneur.2022.823108. eCollection 2022.
To demonstrate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the ipsilesional dorsolateral prefrontal cortex (DLPFC) on neurological recovery in patients with subacute phase stroke.
Patients with supratentorial hemispheric stroke who were hospitalized for intensive rehabilitation in the subacute phase were enrolled for this retrospective analysis. Two groups of patients were selected: the rTMS group who received high-frequency (20 Hz) rTMS ≥ 5 times over the ipsilesional DLPFC, and a control group who did not receive any rTMS. The patients were further divided into groups with right- or left-side brain lesions. Functional measurements for cognitive ability, mood, speech, and activities of daily living, which were assessed at baseline and at the 1-month follow-up as a routine clinical practice, were used for analyses.
Among 270 patients with available clinical data, 133 (women, 51; age, 61.0 ± 13.8 years) met the inclusion criteria and were enrolled for analysis. There were no differences in demographic data and functional scores at baseline between the rTMS ( = 49) and control ( = 84) groups. The rTMS group showed a higher gain in the mini-mental status examination (MMSE) total score and subscores of all domains, forward digit span, and FIM-cognition than the control group ( < 0.05). Among the patients with left hemispheric lesions ( = 57), the rTMS group showed better outcomes in cognition and depression through scores of total and "attention and concentration" subscores of MMSE, FIM-cognition, and the geriatric depression scale ( < 0.05). Among the patients with right hemispheric lesions ( = 76), the rTMS group showed better outcomes in cognition through the MMSE total score and subscores of "attention and concentration," "registration," and "recall," and scores of both forward and backward digit spans ( < 0.05).
High-frequency rTMS over the ipsilesional DLPFC has beneficial effects on the recovery of cognition on both sides as well as mood in patients with left-sided hemispheric lesions.
探讨高频重复经颅磁刺激（rTMS）作用于患侧背外侧前额叶皮质（DLPFC）对亚急性期脑卒中患者神经功能恢复的疗效。
选取亚急性期因强化康复而住院的幕上半球脑卒中患者进行回顾性分析。选择两组患者：rTMS组接受高频（20Hz）rTMS治疗，患侧DLPFC刺激次数≥5次；对照组未接受任何rTMS治疗。患者进一步分为右侧或左侧脑损伤组。将作为常规临床实践在基线和1个月随访时评估的认知能力、情绪、言语及日常生活活动的功能测量结果用于分析。
在270例有可用临床数据的患者中，133例（女性51例；年龄61.0±13.8岁）符合纳入标准并纳入分析。rTMS组（n = 49）和对照组（n = 84）在基线时的人口统计学数据和功能评分无差异。rTMS组在简易精神状态检查表（MMSE）总分及所有领域的分项评分、顺背数字广度和FIM认知方面的改善幅度高于对照组（P<0.05）。在左侧半球损伤患者（n = 57）中，rTMS组在认知和抑郁方面通过MMSE总分及“注意力和集中力”分项评分、FIM认知评分和老年抑郁量表评分显示出更好的结果（P<0.05）。在右侧半球损伤患者（n = 76）中，rTMS组通过MMSE总分及“注意力和集中力”、“记录”和“回忆”分项评分以及顺背和倒背数字广度评分在认知方面显示出更好的结果（P<0.05）。
患侧DLPFC的高频rTMS对左侧半球损伤患者双侧认知恢复及情绪改善有有益作用。
