Relationship between motor function improvements and white matter structure after low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy in chronic subcortical stroke patients
Relationship between motor function improvements and white matter structure after low-frequency repetitive transcranial magnetic stimulation plus intensive occupational therapy in chronic subcortical stroke patients
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DOI：
10.1097/wnr.0000000000001227
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发表时间：
2019-05
期刊：
影响因子：
1.7
通讯作者：
R. Ueda;Naoki Yamada;M. Abo;A. Senoo
中科院分区：
文献类型：
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作者：
R. Ueda;Naoki Yamada;M. Abo;A. Senoo
这是第二篇论文，部分相同的患者组和相同的干预，但不同的解剖结果测量。结合低频重复经颅磁刺激和强化作业疗法的干预可能会改善中风后运动性瘫痪患者的脑功能。本研究的目的是阐明重复经颅磁刺激和作业治疗后全脑白色物质结构的变化。我们招募了25名中风后上肢瘫痪住院15天的患者，在非病变半球接受12次低频重复经颅磁刺激和职业治疗。在非损伤半球的手指的主要运动区施加局灶性重复经颅磁刺激。使用扩散张量成像进行成像分析，以评估干预后白色物质的变化。图论分析进行量化的特点，大脑白色物质网络。我们发现干预后组的总体介数中心性（校正P<0.05）和特征路径长度（校正P<0.05）显著增加。此外，干预后组的整体聚集系数（校正后P<0.05）、小世界性（校正后P<0.05）和整体强度（校正后P<0.05）降低。图论分析表明，我们的干预增加了特征路径长度，并导致更复杂的神经回路，这表明在我们的干预之后，突触连接可能通过结构可塑性在整个网络中增加。我们的研究结果显示了脑卒中神经康复与脑神经结构之间关系的新发现。
This is a second paper on partly the same patient group and the same intervention, but with a different anatomical outcome measurement. An intervention that combines low-frequency repetitive transcranial magnetic stimulation and intensive occupational therapy may improve brain function in poststroke patients with motor paralysis. The aim of this study was to clarify whole-brain white matter structural changes after repetitive transcranial magnetic stimulation and occupational therapy. We recruited 25 patients hospitalized for 15 days with poststroke upper extremity paralysis to receive 12 sessions of low-frequency repetitive transcranial magnetic stimulation over the nonlesioned hemisphere and occupational therapy. Focal repetitive transcranial magnetic stimulation was applied over the primary motor area for the fingers of the nonlesioned hemisphere. Imaging analysis was carried out using diffusion tensor imaging to assess changes in white matter after the intervention. Graph-theoretical analysis was carried out to quantify the characteristics of brain white matter networks. We found a significant increase in global betweenness centrality (corrected P<0.05) and characteristic path length (corrected P<0.05) in the postintervention group. In addition, the global clustering coefficient (corrected P<0.05), small-worldness (corrected P<0.05), and global strength (corrected P<0.05) decreased in the postintervention group. Graph theory analysis suggested that our intervention increased the characteristic path length and led to more complicated neural circuits, indicating that synaptic connections may have increased across the entire network through structural plasticity following our intervention. Our results show novel findings on the relationship between stroke neurorehabilitation and cerebral nerve structure.