Motor Network Reorganization After Repetitive Transcranial Magnetic Stimulation in Early Stroke Patients: A Resting State fMRI Study
Motor Network Reorganization After Repetitive Transcranial Magnetic Stimulation in Early Stroke Patients: A Resting State fMRI Study
复制标题
早期中风患者重复经颅磁刺激后运动网络重组：静息态功能磁共振成像研究
DOI：
10.1177/15459683211054184
复制
发表时间：
2021-10-28
影响因子：
4.2
通讯作者：
Liu, Xinfeng
中科院分区：
文献类型：
--
作者：
Du, Juan;Yao, Weihe;Liu, Xinfeng
目的 比较高频（10 Hz）与低频（1 Hz）重复经颅磁刺激（rTMS）对中风早期运动恢复和皮质运动网络功能重组的影响。方法 纳入46例住院的首例早期（两周内）上肢运动障碍的缺血性脑卒中患者。他们被随机分配到三组，分别接受 10 Hz 同侧 rTMS、1 Hz 对侧 rTMS 和假 rTMS，每天 5 次。所有患者在 rTMS 干预前后均接受运动功能（上肢 Fugl-Meyer）、神经生理学和静息态功能磁共振成像 (fMRI) (rs-fMRI) 评估。运动恢复（oFugl-Meyer 评估）被定义为 rTMS 干预前后运动功能的变化。在三个月随访的时间点重新评估运动功能评估。结果两个真实 rTMS 组比假手术组表现出更大的运动改善。治疗结束后效果至少持续3个月。与假手术组相比，10 Hz 同侧 rTMS 组在同侧初级运动皮层 (M1) 和对侧 M1 之间呈现出增加的静息态功能连接 (FC) (P = .007)，而 1 Hz 对侧 rTMS 组在对侧 M1 和同侧辅助运动区之间呈现出增加的 FC (P = .010)，这与运动恢复呈正相关 (P < .05）。结论 rTMS 对运动恢复的有益作用可能是由于刺激部位和远端运动区之间 FC 的增加，突显了 rTMS 在中风后早期的运动网络重组机制。
Objective To compare the effects of high-frequency (10 Hz) versus low-frequency (1 Hz) repetitive Transcranial Magnetic Stimulation (rTMS) on motor recovery and functional reorganization of the cortical motor network during the early phase of stroke. Methods Forty-six hospitalized, first-ever ischemic stroke patients in early stage (within two weeks) with upper limb motor deficits were recruited. They were randomly allocated to three groups with 10 Hz ipsilesional rTMS, 1 Hz contralesional rTMS, and sham rTMS of five daily session. All patients underwent motor function (Upper Extremity Fugl-Meyer), neurophysiological and resting-state functional Magnetic Resonance Imaging (fMRI) (rs-fMRI) assessments before and after rTMS intervention. Motor recovery (oFugl-Meyer Assessment) was defined as motor function changes before and after rTMS intervention. Motor function assessment was reevaluated at time point of three month follow-up. Results The two real rTMS groups manifested greater motor improvements than the sham group. The effect sustained for at least 3 months after the end of the treatment sessions. Compared with the sham group, 10 Hz ipsilesional rTMS group presented increased resting-state functional connectivity (FC) between ipsilesional primary motor cortex (M1) and contralesional M1 (P = .007), whereas 1 Hz contralesional rTMS group presented increased FC between contralesional M1 and ipsilesional supplementary motor area (P = .010), which were positively correlated with motor recovery (P < .05). Conclusion Beneficial effect of rTMS on motor recovery might be underlaid by increased FC between stimulating site and the remote motor areas, highlighting the motor network reorganization mechanism of rTMS in early post-stroke phase.