Wang Chengshuo, Zhang Linli, Liu Mingyue, Xiang Aomeng, Qi Jingman, Fu Yanxin, Zhao Ruoxuan, Xiong Zheyu, Wu Liang, Zhang Qin
Beijing Xiaotangshan Hospital, Beijing, China.
School of Exercise and Health, Shanghai University of Sport, Shanghai, China.
Front Aging Neurosci. 2025 Sep 10;17:1623039. doi: 10.3389/fnagi.2025.1623039. eCollection 2025.
Deep transcranial magnetic stimulation (dTMS) is more beneficial in activating the leg muscle cortical representation. However, to date, no studies have evaluated the advantages of dTMS compared to repetitive transcranial magnetic stimulation (rTMS) in improving lower extremity motor function in subacute stroke patients. This study aims to compare the efficacy of dTMS and rTMS in treating lower extremity motor dysfunction in subacute stroke patients.
In this single-blind, randomized controlled trial, fifty subacute stroke patients with lower extremity motor dysfunction were randomized to receive either dTMS or rTMS treatment. Patients' Fugl-Meyer Assessment of Lower Extremity (FMA-LE), 10 m Maximum Walking Speed (10 m MWS), Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), walking velocity, stride rate, stride length, gait cycle, double support percentage, and Resting Motor Threshold (RMT) were assessed before the intervention and after the 4-week intervention. Treatment effects were compared using two-way repeated-measures ANOVA. Correlations between lower extremity motor function and cortical excitability were analyzed using Pearson correlation analysis.
Forty-five patients completed the study (dTMS group: = 22; rTMS group: = 23). Two-way repeated measures ANOVA showed significant group × time interaction effects for FMA-LE, 10 m MWS, BBS, TUGT, walking velocity, stride length, gait cycle, and double support percentage. analyses revealed both groups improved significantly from baseline in FMA-LE, 10 m MWS, BBS, TUGT, RMT, walking velocity, stride length, and double support percentage. The dTMS group additionally improved stride rate and gait cycle, while the rTMS group did not. Post-intervention, the dTMS group demonstrated significantly greater improvements than rTMS in FMA-LE, 10 m MWS, TUGT, and walking velocity. After 4 weeks, RMT was significantly negatively correlated with FMA-LE, 10 m MWS, BBS, and walking velocity. RMT was positively correlated with TUGT.
Both dTMS and rTMS can improve lower extremity motor dysfunction in subacute stroke patients. Compared to rTMS, dTMS may provide more facilitative and accelerative effects to promote FMA-LE, TUGT, 10 m MWS, and walking velocity. Therefore, as an adjunct to conventional rehabilitation therapies, dTMS is a valuable therapeutic option in stroke rehabilitation programs.
深部经颅磁刺激（dTMS）在激活腿部肌肉皮质代表区方面更具优势。然而，迄今为止，尚无研究评估dTMS与重复经颅磁刺激（rTMS）相比，在改善亚急性卒中患者下肢运动功能方面的优势。本研究旨在比较dTMS和rTMS治疗亚急性卒中患者下肢运动功能障碍的疗效。
在这项单盲、随机对照试验中，50例患有下肢运动功能障碍的亚急性卒中患者被随机分为接受dTMS或rTMS治疗。在干预前和4周干预后，评估患者的下肢Fugl-Meyer评估量表（FMA-LE）、10米最大步行速度（10m MWS）、伯格平衡量表（BBS）、计时起立行走测试（TUGT）、步行速度、步频、步长、步态周期、双支撑百分比以及静息运动阈值（RMT）。使用双向重复测量方差分析比较治疗效果。使用Pearson相关分析分析下肢运动功能与皮质兴奋性之间的相关性。
45例患者完成了研究（dTMS组：n = 22；rTMS组：n = 23）。双向重复测量方差分析显示，在FMA-LE、10m MWS、BBS、TUGT、步行速度、步长、步态周期和双支撑百分比方面，存在显著的组×时间交互效应。分析显示，两组在FMA-LE、10m MWS、BBS、TUGT、RMT、步行速度、步长和双支撑百分比方面均较基线有显著改善。dTMS组在步频和步态周期方面进一步改善，而rTMS组则没有。干预后，dTMS组在FMA-LE、10m MWS、TUGT和步行速度方面的改善明显大于rTMS组。4周后，RMT与FMA-LE、10m MWS、BBS和步行速度呈显著负相关。RMT与TUGT呈正相关。
dTMS和rTMS均可改善亚急性卒中患者的下肢运动功能障碍。与rTMS相比，dTMS可能提供更多促进和加速作用，以提高FMA-LE、TUGT、10m MWS和步行速度。因此，作为传统康复治疗的辅助手段，dTMS在卒中康复计划中是一种有价值的治疗选择。
