Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Shanghai First Rehabilitation Hospital, Shanghai, China.
CNS Neurosci Ther. 2024 Nov;30(11):e70104. doi: 10.1111/cns.70104.
Limited understanding of neurobiological mechanisms of repetitive transcranial magnetic stimulation (rTMS) prevents us from choosing optimal therapeutic regimen for patients to improve therapeutic efficiency. Resting-state functional magnetic resonance imaging (rs-fMRI) has been demonstrated to obtain comparable functional readouts across species.
Intermittent and continuous theta burst stimulation were used to stimulate ipsilesional and contralesional hemisphere, respectively, during the subacute phase after stroke. We used a rat middle cerebral artery occlusion stroke model. The amplitude of low-frequency fluctuations and functional connectivity analyses of rs-fMRI were chosen to detect neuron activity and functional connectivity. The expression of neuron activation marker c-Fos and axonal plasticity marker GAP43 was examined by an immunochemistry method to corroborate the results of rs-fMRI.
iTBS altered the long-term neuronal activity in bilateral sensorimotor cortex, whereas cTBS influenced immediate neuronal activity of bilateral sensorimotor cortex. In addition, cTBS enhanced interhemispheric and intrahemisheric functional connectivity in contralesional hemisphere, accompanied by axonal and dendritic remodeling in the perilesional cortical areas and contralesional homologous areas after large stroke.
rTMS exerted complex effects on brain structural and functional connectivity in addition to affecting cortical excitability. cTBS promoted the compensatory effect of contralesional hemisphere after stroke with large lesions.
由于对重复经颅磁刺激（rTMS）的神经生物学机制了解有限，我们无法为患者选择最佳治疗方案以提高治疗效果。静息态功能磁共振成像（rs-fMRI）已被证明可在不同物种中获得可比的功能读数。
在中风后亚急性期，分别使用间歇性和连续性经颅磁刺激刺激同侧和对侧半球。我们使用了大鼠大脑中动脉闭塞中风模型。选择 rs-fMRI 的低频波动幅度和功能连接分析来检测神经元活动和功能连接。通过免疫化学方法检查神经元激活标志物 c-Fos 和轴突可塑性标志物 GAP43 的表达，以证实 rs-fMRI 的结果。
iTBS 改变了双侧感觉运动皮层的长期神经元活动，而 cTBS 影响了双侧感觉运动皮层的即刻神经元活动。此外，cTBS 增强了对侧半球的大脑半球间和半球内功能连接，伴有皮质损伤区和对侧同源区的轴突和树突重塑。
rTMS 除了影响皮质兴奋性外，还对大脑结构和功能连接产生复杂影响。cTBS 促进了大病灶中风后对侧半球的代偿效应。
