Effect of cerebellar low frequency rTMS on lower lamb motor function and cortical excitability in patients with posterior circulation stroke

doi:10.3877/cma.j.issn.2095-123X.2020.06.008

Abstract

Abstract:

Objective

To observe the effects of repetitive transcranial magnetic stimulation (rTMS) on lower extremity motor function and cerebral cortex excitability in patients with posterior circulation stroke(PCS), and to explore its mechanism.

Methods

Twenty-seven stroke patients with PCS, admitted to Rehabilitation Medicine Department of The First People’s Hospital of Yichang from January to December 2019, were randomly divided into treatment group (n=13) and control group (n=14). Patients in both groups received routine physiotherapy, and the patients in the treatment group were treated with rTMS. The stimulation site was the contralateral cerebellum (the body surface was located at the site of 3 cm adjacent to the trochanter of the occipital bone and moved downward to 1 cm), the repetition rate was 80% resting motor threshold (RMT), and the number of stimuli was 1600, once a day for 4 consecutive weeks. The stimulation parameters of the control group were the same as those of the treatment group, but only sound cues. Fugl-Meyer motor scale (FMA), Fugl-Meyer balance scale (FMBS) and Wisconsin gait scale (WGS) walking function were used to evaluate the function of the patients before and 4 weeks after treatment. At the same time, the changes of RMT and cortical motor evoked potential (MEP) amplitude were measured, and the correlation between the improvement of motor function and cortical excitability was analyzed.

Results

After 4 weeks of treatment, the scores of FMA, FMBS and WGS increased, RMT decreased and MEP amplitude increased in the two groups (P<0.05), and the changes of RMT and MEP amplitudes in the treatment group were more obvious than those in the control group (P<0.05). The negative correlation between the improvement of FMBS and the change of RMT (P<0.05).

Conclusion

Low frequency rTMS acting on the cerebellum can effectively improve the balance function of patients with PCS, and its mechanism may be that it increases the cortical excitability of the brain.

Key words: Cerebellar, Posterior circulation stroke, Repetitive transcranial magnetic stimulation, Resting motor threshold, Motor evoked potential

Qiang Duan, Liangwen Sun, Chunxia Wei, Min Lu, Fengli Yu, Jie Huang, Xiaoqun Huang. Effect of cerebellar low frequency rTMS on lower lamb motor function and cortical excitability in patients with posterior circulation stroke[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2020, 10(06): 352-356.

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References 21

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项目	治疗组（n=13）	对照组（n=14）	χ²/t值	P值
年龄（年，Mean±SD）	46.77±9.56	47.86±6.50	0.349	0.728
性别（男/女）	7/6	6/8	0.326	0.713
病程（周，Mean±SD）	5.77±1.24	4.93±1.00	1.944	0.081
PCS梗死部位（左/右）	8/5	7/7	0.364	0.704
MMSE评分（分，Mean±SD）	22.77±1.79	22.57±2.17	0.260	0.786
NISHH评分（分，Mean±SD）	6.23±2.20	6.14±2.18	0.107	0.923

项目	治疗组（n=13）	对照组（n=14）	χ²/t值	P值
年龄（年，Mean±SD）	46.77±9.56	47.86±6.50	0.349	0.728
性别（男/女）	7/6	6/8	0.326	0.713
病程（周，Mean±SD）	5.77±1.24	4.93±1.00	1.944	0.081
PCS梗死部位（左/右）	8/5	7/7	0.364	0.704
MMSE评分（分，Mean±SD）	22.77±1.79	22.57±2.17	0.260	0.786
NISHH评分（分，Mean±SD）	6.23±2.20	6.14±2.18	0.107	0.923

项目	治疗组（n=13）				对照组（n=14）
项目	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
FMA（下肢）	19.31±1.31	26.18±1.24	13.732	0.001	18.75±1.08	24.73±1.42^a	12.542	0.001
FMBS（平衡）	5.31±1.08	8.38±1.14	7.049	0.001	5.19±1.21	6.73±1.03^a	3.626	0.003
WGS（步行）	15.31±1.64	8.18±1.85	10.399	0.001	14.61±1.28	11.73±1.43^a	5.615	0.001
RMT（%）	60.51±5.93	51.23±4.28	4.575	0.001	59.84±3.72	57.56±5.18^a	2.373	0.041
MEP波幅（μV）	2.84±0.59	3.31±0.56	2.083	0.034	2.68±0.61	2.86±0.54^a	2.827	0.026

项目	治疗组（n=13）				对照组（n=14）
项目	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
FMA（下肢）	19.31±1.31	26.18±1.24	13.732	0.001	18.75±1.08	24.73±1.42^a	12.542	0.001
FMBS（平衡）	5.31±1.08	8.38±1.14	7.049	0.001	5.19±1.21	6.73±1.03^a	3.626	0.003
WGS（步行）	15.31±1.64	8.18±1.85	10.399	0.001	14.61±1.28	11.73±1.43^a	5.615	0.001
RMT（%）	60.51±5.93	51.23±4.28	4.575	0.001	59.84±3.72	57.56±5.18^a	2.373	0.041
MEP波幅（μV）	2.84±0.59	3.31±0.56	2.083	0.034	2.68±0.61	2.86±0.54^a	2.827	0.026

评分	组别	例数	RMT		MEP波幅
评分	组别	例数	r值	P值	r值	P值
FMA	治疗组	13	-0.239	0.321	0.732	0.851
FMA	对照组	14	-0.431	0.527	0.009	0.175
FMBS	治疗组	13	-0.534	0.016	0.732	0.062
FMBS	对照组	14	-0.493	0.577	0.329	0.178
WGS	治疗组	13	-0.528	0.316	0.732	0.632
WGS	对照组	14	-0.476	0.732	0.195	0.175

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