使用双重靶向 rTMS、单一靶向 rTMS 或假 rTMS 治疗脑卒中后认知障碍。
Using Dual-Target rTMS, Single-Target rTMS, or Sham rTMS on Post-Stroke Cognitive Impairment.
机构信息
College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, 201318 Shanghai, China.
Rehabilitation Department, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), 201620 Shanghai, China.
出版信息
J Integr Neurosci. 2024 Aug 23;23(8):161. doi: 10.31083/j.jin2308161.
BACKGROUND
The clinical application of 10 Hz repetitive transcranil magnetic stimulation (rTMS) remains limited despite its demonstrated effectiveness in enhancing cortical excitability and improving cognitive function. The present study used a novel stimulus target [left dorsolateral prefrontal cortex + primary motor cortex] to facilitate the enhancement of cognitive function through the bidirectional promotion of cognitive and motor functions; Methods: Post-stroke cognitive impairment patients ( = 48) were randomly assigned to receive either dual-target, single-target, or sham rTMS for 4 weeks. Before and after 4 weeks of treatment, participants were asked to complete the Montreal Cognitive Assessment (MoCA) test, the Modified Barthel Index (MBI), the Trail-making Test (TMT), and the Digital Span Test (DST). In addition, the levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) in serum were also measured.
RESULTS
After adjusting for pre-intervention (baseline) MoCA scores, the post-intervention MoCA scores varied significantly. After post-hoc analysis, differences existed between the post-treatment scores of the dual-target rTMS group and the sham rTMS group (the experimental group scores were significantly higher), and between those of the dual-target rTMS group and the single-target rTMS group (the dual-target rTMS scores were significantly higher). The serum VEGF levels of the dual-target rTMS group were significantly higher those that of the sham rTMS group.
CONCLUSIONS
The present study presented data showing that a dual-target rTMS therapy is effective for Post-stroke cognitive impairment (PSCI). The stimulation exhibited remarkable efficacy, suggesting that dual-target stimulation (left dorsolateral prefrontal cortex+motor cortex (L-DLPFC+M1)) holds promise as a potential target for TMS therapy in individuals with cognitive impairment after stroke.
CLINICAL TRIAL REGISTRATION
No: ChiCTR220066184. Registered 26 November, 2022, https://www.chictr.org.cn.
背景
尽管 10Hz 重复经颅磁刺激（rTMS）已被证实能增强皮质兴奋性和改善认知功能，但在临床应用中仍受到限制。本研究采用新的刺激靶点[左背外侧前额叶皮质+初级运动皮质]，通过认知和运动功能的双向促进来促进认知功能的增强；方法：将 48 例脑卒中后认知障碍患者随机分为双靶 rTMS、单靶 rTMS 和假刺激 rTMS 组，分别接受 4 周治疗。治疗前和治疗 4 周后，所有患者均完成蒙特利尔认知评估（MoCA）、改良巴氏指数（MBI）、连线测试（TMT）和数字跨度测试（DST）。同时检测血清脑源性神经营养因子（BDNF）和血管内皮生长因子（VEGF）水平。
结果
调整治疗前（基线）MoCA 评分后，治疗后 MoCA 评分差异有统计学意义。事后分析显示，双靶 rTMS 组和假刺激 rTMS 组治疗后 MoCA 评分差异有统计学意义（实验组评分显著升高），双靶 rTMS 组和单靶 rTMS 组治疗后 MoCA 评分差异有统计学意义（双靶 rTMS 评分显著升高）。双靶 rTMS 组血清 VEGF 水平明显高于假刺激 rTMS 组。
结论
本研究提供的数据表明，双靶 rTMS 治疗对脑卒中后认知障碍（PSCI）有效。这种刺激表现出显著的疗效，表明双靶刺激（左背外侧前额叶皮质+运动皮质（L-DLPFC+M1））作为脑卒中后认知障碍患者 TMS 治疗的潜在靶点具有一定的潜力。
临床试验注册
无：ChiCTR220066184。注册日期：2022 年 11 月 26 日，网址：www.chictr.org.cn。
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