Jin Yu, Bai Xi, Jiang Binghu, Guo Zhiwei, Mu Qiwen
Department of Radiology, Chengdu Second People's Hospital, Chengdu, China.
Department of Radiology, Langzhong People's Hospital, Langzhong, China.
Front Hum Neurosci. 2022 Apr 6;16:829688. doi: 10.3389/fnhum.2022.829688. eCollection 2022.
To explore the changes of cerebral blood flow (CBF) and fractional anisotropy (FA) in stroke patients with motor dysfunction after repetitive transcranial magnetic stimulation (rTMS) treatment, and to better understand the role of rTMS on motor rehabilitation of subcortical stroke patients from the perfusion and structural level.
In total, 23 first-episode acute ischemic stroke patients and sixteen healthy controls (HCs) were included. The patients were divided into the rTMS and sham group. The rehabilitation assessments and examination of perfusion and structural MRI were performed before and after rTMS therapy for each patient. Voxel-based analysis was used to detect the difference in CBF and FA among all three groups. The Pearson correlation analysis was conducted to evaluate the relationship between the CBF/FA value and the motor scales.
After rTMS, significantly increased CBF was found in the ipsilesional supplementary motor area, postcentral gyrus, precentral gyrus, pons, medulla oblongata, contralesional midbrain, superior cerebellar peduncle, and middle cerebellar peduncle compared to that during the prestimulation and in the sham group, these fasciculi comprise the cortex-pontine-cerebellum-cortex (CPC) loop. Besides, altered CBF in the ipsilesional precentral gyrus, postcentral gyrus, and pons was positively associated with the improved Fugl-Meyer assessment (FMA) scores. Significantly decreased FA was found in the contralesional precentral gyrus, increased FA was found in the ipsilesional postcentral gyrus, precentral gyrus, contralesional supplementary motor area, and bilateral cerebellum, these fasciculi comprise the corticospinal tract (CST). The change of FMA score was positively correlated with altered FA value in the ipsilesional postcentral gyrus and negatively correlated with altered FA value in the contralesional precentral gyrus.
Our results suggested that rTMS could facilitate the motor recovery of stroke patients. High frequency could promote the improvement of functional activity of ipsilesional CPC loop and the recovery of the microstructure of CST.
探讨重复经颅磁刺激（rTMS）治疗后运动功能障碍的脑卒中患者脑血流（CBF）和分数各向异性（FA）的变化，从灌注和结构水平更好地理解rTMS对皮质下脑卒中患者运动康复的作用。
共纳入23例首发急性缺血性脑卒中患者和16例健康对照者（HCs）。将患者分为rTMS组和假刺激组。对每位患者在rTMS治疗前后进行康复评估以及灌注和结构MRI检查。采用基于体素的分析方法检测三组之间CBF和FA的差异。进行Pearson相关分析以评估CBF/FA值与运动量表之间的关系。
与刺激前及假刺激组相比，rTMS治疗后，患侧辅助运动区、中央后回、中央前回、脑桥、延髓、对侧中脑、小脑上脚和小脑中脚的CBF显著增加，这些纤维束构成皮质 - 脑桥 - 小脑 - 皮质（CPC）环路。此外，患侧中央前回、中央后回和脑桥CBF的改变与Fugl - Meyer评估（FMA）评分的改善呈正相关。对侧中央前回FA显著降低，患侧中央后回、中央前回、对侧辅助运动区和双侧小脑FA增加，这些纤维束构成皮质脊髓束（CST）。FMA评分的变化与患侧中央后回FA值的改变呈正相关，与对侧中央前回FA值的改变呈负相关。
我们的结果表明，rTMS可促进脑卒中患者的运动恢复。高频刺激可促进患侧CPC环路功能活动的改善和CST微观结构的恢复。
