Low frequency rTMS and fluoxetine for motor recovery after ischemic stroke

低频 rTMS 和氟西汀用于缺血性中风后运动恢复

• 批准号: 8918015
• 负责人: Felipe Fregni
• 金额: $ 24.13万
• 依托单位: SPAULDING REHABILITATION HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8918015
• 关键词: Accounting; Activities of Daily Living; Affect; Age; American Heart Association; Area; Biological Neural Networks; Brain; Clinical; Combined Modality Therapy; Control Groups; Evaluation; Fluoxetine; Frequencies; Future; Goals; Health; Intervention; Ischemic Stroke; Knowledge; Long-Term Potentiation; Measurement; Mental Depression; Motor; Motor Cortex; Motor Evoked Potentials; Motor Skills; Multicenter Trials; Neuronal Plasticity; Occupational Therapy; Patients; Pattern; Performance; Pharmacotherapy; Physical therapy; Physiologic pulse; Placebo Control; Placebos; Population; Process; Property; Recovery; Recruitment Activity; Rehabilitation therapy; Research; Research Project Grants; Role; Selective Serotonin Reuptake Inhibitor; Sertraline; Stroke; System; Testing; Therapeutic; Treatment Protocols; United States; base; disability; experience; functional outcomes; improved; indexing; motor function improvement; motor learning; motor recovery; neurophysiology; neuroregulation; post intervention; post stroke; repetitive transcranial magnetic stimulation; restoration; skill acquisition; stroke recovery; stroke rehabilitation; success

DESCRIPTION (provided by applicant): The goal of this proposal is to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with pharmacotherapy (fluoxetine) in the rehabilitation of post-stroke subjects. This research will help to reveal the relationship between function restorations via pharmacological intervention when combined with noninvasive neuromodulation in patients after ischemic stroke. Stroke is the leading cause of disability in the United States (Nowak et al., 2009) According to the American Heart Association, over 795,000 people experience stroke annually in the USA (Lloyd-Jones et al., 2009). Unfortunately, restitution of post-stroke motor function is frequently incomplete, with the majorit of stroke patients unable to perform professional duties or activities of daily living by six month after their stroke (Hummel and Cohen, 2006). Currently, there are only a few treatments available to improve motor function in stroke; most of them are based on motor learning strategies. Although these treatments may improve motor function significantly, their effects are often limited. The general objective of this research project is to assess the clinical and neurophysiological properties of rTMS and fluoxetine to promote motor recovery in post-stroke subjects as indexed by clinical motor function scales. This will be done by delivering low-frequency rTMS over the brain primary motor cortex (M1) in the unaffected hemisphere while the subjects are receiving fluoxetine treatment, subjects will be assessed at one and three months post intervention. Finally, we will investigate the mechanisms of this treatment by studying the induced neurophysiological and functional changes. This will be indexed by motor evoked potentials, cortical excitability/inhibition measurements, transcallosal inhibition evaluation, and paired associative stimulation. Regarding assurance of success, this proposal has two main specific aims: Aim 1: To determine whether low-frequency rTMS associated with fluoxetine offers additional benefits on motor rehabilitation and retention of motor skills, than pharmacotherapy alone. Aim 2: To determine the effects on cortical excitability when rTMS is combined with pharmacotherapy, whether fluoxetine is capable to induce positive or negative effects in M1 neuromodulation.

描述(申请人提供)：本提案的目标是研究重复经颅磁刺激(RTMS)联合药物疗法(氟西汀)在中风后患者康复中的作用。这项研究将有助于揭示缺血性卒中后通过药物干预与非侵入性神经调节相结合进行功能恢复之间的关系。中风是美国残疾的主要原因(Nowak等人，2009年)根据美国心脏协会的数据，美国每年有超过795,000人中风(Lloyd-Jones等人，2009年)。不幸的是，中风后运动功能的恢复往往不完全，大部分中风患者在中风后六个月内无法履行专业职责或进行日常生活活动(Hummel和Cohen，2006)。目前，改善中风患者运动功能的治疗方法很少，大部分都是基于运动学习策略。尽管这些疗法可能会显著改善运动功能，但它们的效果往往有限。这项研究的总体目标是评估rTMS和氟西汀的临床和神经生理学特性，以促进中风后患者的运动恢复，以临床运动功能评分为指标。这将通过在未受影响的半球的大脑初级运动皮质(M1)上传递低频rTMS来实现，同时受试者正在接受氟西汀治疗，受试者将在干预后1个月和3个月进行评估。最后，我们将通过研究诱导的神经生理和功能变化来探讨该疗法的作用机制。这将通过运动诱发电位、皮质兴奋性/抑制测量、经颧骨抑制评估和配对联想刺激来指标化。关于成功的保证，这项建议有两个主要的具体目标：目标1：确定与氟西汀相关的低频rTMS是否比单纯药物治疗在运动康复和运动技能保留方面提供额外的好处。目的：观察rTMS联合药物治疗对大脑皮层兴奋性的影响，探讨氟西汀对M1神经调节的正性或负性作用。

项目成果

A combined therapeutic approach in stroke rehabilitation: A review on non-invasive brain stimulation plus pharmacotherapy.

• DOI: 10.4172/2376-0281.1000123
• 发表时间: 2014-11-01
• 期刊: International journal of neurorehabilitation
• 作者: Perez, Carolina;Morales-Quezada, Leon;Fregni, Felipe
• 通讯作者: Fregni, Felipe

SSRI and Motor Recovery in Stroke: Reestablishment of Inhibitory Neural Network Tonus.

• DOI: 10.3389/fnins.2017.00637
• 发表时间: 2017
• 期刊: Frontiers in neuroscience
• 影响因子: 4.3
• 作者: Pinto CB;Saleh Velez FG;Lopes F;de Toledo Piza PV;Dipietro L;Wang QM;Mazwi NL;Camargo EC;Black-Schaffer R;Fregni F
• 通讯作者: Fregni F

Notes on Human Trials of Transcranial Direct Current Stimulation between 1960 and 1998.

• DOI: 10.3389/fnhum.2017.00071
• 发表时间: 2017
• 期刊: Frontiers in human neuroscience
• 影响因子: 2.9
• 作者: Esmaeilpour Z;Schestatsky P;Bikson M;Brunoni AR;Pellegrinelli A;Piovesan FX;Santos MM;Menezes RB;Fregni F
• 通讯作者: Fregni F

Neurophysiologic predictors of motor function in stroke.

中风运动功能的神经生理学预测因素。

• DOI: 10.3233/rnn-150550
• 发表时间: 2016
• 期刊: Restorative neurology and neuroscience
• 影响因子: 2.8
• 作者: Simis,Marcel;Doruk,Deniz;Imamura,Marta;Anghinah,Renato;Morales-Quezada,Leon;Fregni,Felipe;Battistella,LinamaraRizzo
• 通讯作者: Battistella,LinamaraRizzo

Safety Review of Transcranial Direct Current Stimulation in Stroke.

• DOI: 10.1111/ner.12574
• 发表时间: 2017-04
• 期刊: Neuromodulation : journal of the International Neuromodulation Society
• 作者: Russo C;Souza Carneiro MI;Bolognini N;Fregni F
• 通讯作者: Fregni F