Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients: Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments

作者：Juan Du, Fang Yang, Jianping Hu, Jingze Hu, Qiang Xu, Nathan Cong, Qirui Zhang, Ling Liu, Dante Mantini, Zhiqiang Zhang, Guangming Lu, Xinfeng Liu · 发表于：NeuroImage Clinical · 年份：2018 · DOI：10.1016/j.nicl.2018.101620 · 被引用次数：224 · 研究领域：Transcranial Magnetic Stimulation Studies、Stroke Rehabilitation and Recovery、Spatial Neglect and Hemispheric Dysfunction

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability, and may be beneficial for motor recovery after stroke. However, the neuroplasticity effects of rTMS have not been thoroughly investigated in the early stage after stroke. OBJECTIVE: To comprehensively assess the effects of high- and low-frequency repetitive transcranial magnetic stimulations on motor recovery in early stroke patients, using a randomized controlled trial based on clinical, neurophysiological and functional imaging assessments. METHODS: Sixty hospitalized, first-ever ischemic stroke patients (within 2 weeks after stroke) with motor deficits were randomly allocated to receive, in addition to standard physical therapy, five consecutive sessions of either: (1) High-frequency (HF) rTMS at 10 Hz over the ipsilesional primary motor cortex (M1); (2) Low-frequency (LF) rTMS at 1 Hz over the contralesional M1; (3) sham rTMS. The primary outcome measure was a motor impairment score (Upper Extremity Fugl-Meyer) evaluated at baseline, after rTMS intervention, and at 3-month follow-up. Cortical excitability and functional magnetic resonance imaging (fMRI) data were obtained within 24 h before and after rTMS intervention. Analyses of variance were conducted to compare the recovery effects among the three rTMS groups, assessed using clinical, neurophysiological and fMRI tests. RESULTS: Motor improvement was significantly larger in the two rTMS groups than in the control group. ...