To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of ischemic stroke patients with hemiplegia by diffusion tensor imaging (DTI), and to explore the potential mechanism of rTMS in improving motor function in patients with ischemic stroke.

Forty stroke patients admitted by the Rehabilitation Medicine Department of Baotou Central Hospital from October 2020 to December 2021 were selected as the research objects, and were divided into treatment group and control group according to the random number table, with 20 patients in each group. All patients were given basic medication and conventional rehabilitation treatment, and low-frequency (1 Hz) rTMS treatment was added to the treatment group on this basis. The treatment was given 5 d per week for a total duration of 4 weeks. The National Institutes of Health stroke scale (NIHSS), the Fugl-Meyer motor function assessment (FMA), and the modified Bartholomew index (MBI) scores were collected before and after treatment. The relative fractional anisotropy scores (rFA) were calculated and then compared and analyzed.

After 4 weeks of treatment, the NIHSS scores of patients in the treatment and control groups decreased compared with before, and the FMA and MBI scores improved compared with before receiving treatment (P<0.05), and the improvement was more significant in the treatment group (P<0.01). The DTI parameters before and after treatment, in which the FA and rFA values of the radiographic coronal area and the posterior limb of the internal capsule in the treatment group were improved compared with those before treatment (P<0.05), and the differences in FA and rFA values of the radiographic coronal area and the posterior limb of the internal capsule in the control group before and after treatment were not statistically significant (P>0.05). Correlation analysis showed that the FA and rFA values of the radiographic coronal area on the side of the lesion in the treatment group were negatively correlated with the NIHSS score (P<0.05) and positively correlated with the FMA and MBI scores (P<0.05); the FA and rFA values of the posterior limb of the internal capsule were positively correlated with the MBI score, and did not significantly correlate with the NIHSS and FMA scores (P>0.05).

Conventional rehabilitation treatment and rTMS treatment can improve the motor function of patients with ischemic stroke, and the combination of the two is more effective. DTI confirmed that traditional rehabilitation therapy combined with rTMS can improve the integrity of nerve fiber bundle, which may be the potential mechanism of rTMS to improve motor function in patients with ischemic stroke hemiplegia.