Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan.
Department of Rehabilitation Medicine, the Jikei University School of Medicine, Tokyo, Japan.
J Neurol Sci. 2022 Dec 15;443:120473. doi: 10.1016/j.jns.2022.120473. Epub 2022 Oct 27.
Although high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) in chronic intracerebral hemorrhage (ICH) is beneficial, it has been poorly investigated in rTMS for acute ICH. Our aim is to investigate the effects and safety of rTMS in acute spontaneous ICH.
We prospectively performed HF-rTMS on consecutive patients with ICH within 24 h from onset between April 2019 and August 2021. The inclusion criterion was (1) persistent paralysis, with an NIHSS scale of 1 or higher for at least 3 days after onset. The exclusion criteria were (1) cortical, subcortical, and cerebellar ICH, (2) disturbance of consciousness, and (3) over 80 years of age. For the purpose of comparison, we used a conventional rehabilitation group whose patients met the same criteria between April 2016 and March 2019. We evaluated incidence of epilepsy and exacerbation of the NIHSS score in the rTMS group. We also compared the two groups regarding clinical background and outcome.
Enrolled in the study were a total of 44 patients. Of the patients, 22 (50%) were in the rTMS group. The median (IQR) time from onset to the start of rTMS was 9 (6-12) days. There were no cases of epilepsy or exacerbation of NIHSS after the start of rTMS. Favorable outcome (modified Rankin Scale score of between 0 and 2) at 3 months was frequently observed in the rTMS group (73% vs 27%, p = 0.006). HF-rTMS was independently associated with favorable outcome at 3 months (OR = 11.5, 95% CI = 2.194-60.447, p = 0.004).
HF-rTMS may be safe and effective in acute ICH patients.
高频重复经颅磁刺激（HF-rTMS）在慢性脑出血（ICH）中有益，但在急性 ICH 中的 rTMS 研究甚少。我们旨在研究急性自发性 ICH 中 rTMS 的效果和安全性。
我们前瞻性地对 2019 年 4 月至 2021 年 8 月发病 24 小时内的连续ICH 患者进行 HF-rTMS。纳入标准为：（1）持续瘫痪，发病后至少 3 天 NIHSS 评分为 1 或更高。排除标准为：（1）皮质、皮质下和小脑 ICH；（2）意识障碍；（3）年龄超过 80 岁。为了比较，我们使用了常规康复组，其患者在 2016 年 4 月至 2019 年 3 月符合相同标准。我们评估 rTMS 组癫痫发作和 NIHSS 评分恶化的发生率。我们还比较了两组的临床背景和结局。
共纳入 44 例患者，其中 22 例（50%）为 rTMS 组。rTMS 开始时间距发病的中位数（IQR）为 9（6-12）天。rTMS 开始后无癫痫发作或 NIHSS 恶化病例。rTMS 组 3 个月时预后良好（改良 Rankin 量表评分 0-2）的发生率较高（73%比 27%，p=0.006）。HF-rTMS 与 3 个月时的良好预后独立相关（OR=11.5，95%CI=2.194-60.447，p=0.004）。
HF-rTMS 可能对急性 ICH 患者安全且有效。
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