Zhao Li, Chen Li, Wang Chunyan, Li Sha, Wan Chunxiao
Department of Rehabilitation, Tianjin Medical University General Hospital, Tianjin, China.
Department of Imaging, Tianjin Medical University General Hospital, Tianjin, China.
Front Neurol. 2024 Sep 30;15:1454220. doi: 10.3389/fneur.2024.1454220. eCollection 2024.
Repetitive transcranial magnetic stimulation (rTMS) can improve post stroke motor function. However, there is little research on targets. The purpose of this study is to investigate the effects of rTMS therapy with different targets on post stroke motor function and neural plasticity.
Fifty-four subjects were randomly divided into M1 (Primary motor area) group, SMA (supplementary motor area) group and Sham group, and were given 10 Hz on the affected M1 area, SMA area and sham stimulation rTMS. The primary outcomes included Fugl-Meyer Assessment Upper Extremity Scale (FMA-UE), Fugl-Meyer Assessment Lower Extremity Scale (FMA-LE) and Berg balance scale (BBS). Secondary outcomes: amplitude of low frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity (FC) were analyzed by functional magnetic resonance imaging (fMRI) to evaluate brain functional activation and functional connectivity changes.
The 2-way repeated-measures ANOVA revealed a significant group × time interaction ( = 23.494, < 0.001; = 10.801, < 0.001; = 17.812, < 0.001) in the FMA-UE, FMA-LE and BBS scores. analysis indicated that 4 weeks of SMA rTMS resulted in an increase in FMA-UE, FMA-LE and BBS scores compared with Sham group ( = 0.006; = 0.033; = 0.012), SMA group was significantly increased in BBS compared with M1 group ( = 0.034). Moreover, there were significant effects of time in all 3 groups in the FMA-UE, FMA-LE and BBS scores ( < 0.001). In addition, the increase of ALFF in the supramarginal gyrus on the affected side was correlated with better FMA-UE recovery, the increase of ALFF in the middle temporal gyrus and the middle frontal gyrus on the affected side was positively correlated with the improvement of BBS, and the ALFF in the cerebellum on the healthy side was negatively correlated with the improvement of BBS. There was a positive correlation between FC (SMA - ipsilateral cerebellum) changes and BBS changes in SMA group.
In conclusion, SMA-rTMS intervention has a better recovery effect on motor dysfunction after stroke than Sham-rTMS. SMA-rTMS led to similar improvement on motor function but significantly greater improvement on balance compared to M1-rTMS, and this may pave a new way for stroke rehabilitation.
Registration number: ChiCTR2200060955, https://www.chictr.org.cn/.
重复经颅磁刺激（rTMS）可改善脑卒中后的运动功能。然而，关于刺激靶点的研究较少。本研究旨在探讨不同靶点的rTMS治疗对脑卒中后运动功能和神经可塑性的影响。
54名受试者被随机分为M1（初级运动区）组、SMA（辅助运动区）组和假刺激组，并在患侧M1区、SMA区给予10Hz的rTMS刺激以及假刺激。主要结局指标包括Fugl-Meyer上肢运动功能评定量表（FMA-UE）、Fugl-Meyer下肢运动功能评定量表（FMA-LE）和Berg平衡量表（BBS）。次要结局指标：通过功能磁共振成像（fMRI）分析低频振幅（ALFF）、局部一致性（ReHo）和功能连接（FC），以评估脑功能激活和功能连接变化。
双向重复测量方差分析显示，FMA-UE、FMA-LE和BBS评分存在显著的组×时间交互作用（F = 23.494，P < 0.001；F = 10.801，P < 0.001；F = 17.812，P < 0.001）。事后检验表明，与假刺激组相比，4周的SMA区rTMS导致FMA-UE、FMA-LE和BBS评分增加（P = 0.006；P = 0.033；P = 0.012），SMA组的BBS评分与M1组相比显著增加（P = 0.034）。此外，所有3组的FMA-UE、FMA-LE和BBS评分在时间上均有显著影响（P < 0.001）。此外，患侧缘上回ALFF的增加与FMA-UE的更好恢复相关，患侧颞中回和额中回ALFF的增加与BBS的改善呈正相关，而健侧小脑的ALFF与BBS的改善呈负相关。SMA组中FC（SMA-同侧小脑）变化与BBS变化之间存在正相关。
总之，与假刺激rTMS相比，SMA-rTMS干预对脑卒中后运动功能障碍具有更好的恢复效果。与M1-rTMS相比，SMA-rTMS在运动功能上导致类似的改善，但在平衡方面有显著更大的改善，这可能为脑卒中康复开辟一条新途径。
注册号：ChiCTR2200060955，https://www.chictr.org.cn/ 。
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