Study Of FNIRS In Effect Of RTMS For Upper Limb Movement Function In Patients With Stroke

Objective:The aim of this study was to investigate the change of cortical activation pattern during execution of paralyzed upper limb movement in patients with stroke after repetitive transcranial magnetic stimulation(rTMS),using functional near infrared spectroscopy(fNIRS).Methods:30 patients with ischemic cerebral infarction of middle cerebral artery in the early stage were randomly assigned to two groups:the rTMS group and the sham group.Patients of the rTMS group were receiving 1Hz rTMS on M1 area of the unaffected hemisphere,once a day of 20 minutes,and totally 20 days.Under the condition of giving the same rehabilitation therapy,respectively before and after treatment for 10 days,the day immediately after treatment and 1 month after treatment,the Fugl-Meyer motor assessment(FMA)of upper limb was used to assess the paralyzed upper limb movement function in the patients with stroke.Simultaneously we measured oxy-hemoglobin(Hb02)in six regions of interest(ROI)during paralyzed upper limb movement before and after 21 days treatment both in the rTMS group and the sham group using functional near infrared spectroscopy(fNIRS).The six ROI areas respectively are premotor cortex(PMC),supplementary motor area(SMA)and sensorimotor(SMC)of the affected hemisphere and the unaffected hemisphere.Results:The score of the FMA significantly improved in both groups after treatment.After treatment,the FMA in the rTMS group was obviously higher than the sham group(P<0.05),1 month after treatment the gap has become more significant(P<0.01).In both groups,during the pre-treatment motor phase,the Hb02 value in SMC of the unaffected hemisphere was higher than those of other ROIs.In the rTMS group,during the post-treatment motor phase,Hb02 value variation in SMC of the unaffected hemisphere showed a significant decrease,compared with that of sham group(p<0.01),and Hb02 value in SMC of the affected hemisphere showed a significant increase(p<0.01),while the change of Hb02 value in PMC and SMA of both hemisphere no statistical significance(P>0.05).Conclusion:Results of this study showed that rTMS on the unaffected hemisphere induced a decrease of cortical activation in unaffected SMC,and a increase of cortical activation in affected SMC,during execution of paralyzed upper limb movement,and promote the recovery of upper limb function.