The Efficacy Of Repetitive Transcranial Magnetic Stimulation In The Treatment Of Spinocerebellar Ataxia

Objective: The purpose of this study was to observe the efficacy of high frequency r TMS in the treatment of spinocerebellar ataxia and the changes of brain Re Ho after r TMS,and to explore its therapeutic mechanism.Methods: A total of 20 patients genetically diagnosed with spinocerebellar ataxia were randomly divided into two groups: stimulation group and sham stimulation group.Before treatment both groups were evaluated via the SARA ataxia scale,the Berg balance scale,the 10-meter walking test and rs-f MRI.High-frequency(5Hz)r TMS was administered daily to stimulate bilateral cerebellar hemispheres with a total of 1800 pulses for 18 minutes,five days a week for 2 weeks.After treatment,the subjects were again evaluated using the above scales as well as rs-f MRI.Statistical analysis of measured data was carried using SPSS 25,and the image data pre-processing and Re Ho value analyses were carried out by using the Matlab 2014 a restplus tool.Results: 1.The SARA score of patients in the stimulation group after r TMS treatment was lower than that before treatment,and the BBS scale scores were higher than before treatment,both results were statistically significant.There was no statistical difference between the normal speed and the fastest speed of the 10-meter walking test as the speeds post-treatment did not change significantly compared to speeds pre-treatment.In the sham stimulation group,there was no significant change in scores of either scale after r TMS treatment,and there was no statistical difference.Comparison of the stimulation and sham stimulation groups showed that the changes in the scores of SARA and BBS scale were statistically significant.2.In the stimulation group,Re Ho in the left middle frontal gyrus decreased after r TMS treatment,while the increased areas of Re Ho were the left precentral gyrus,right putamen,right superior temporal gyrus,left superior parietal marginal gyrus and left occipital lobe;there was no significant change in Re Ho in the before and after treatment in the sham stimulation group;Re Ho increased in the left posterior cerebellar lobe between the two groups.Conclusion: This study found that high frequency r TMS can improve the ataxic motor symptoms of spinocerebellar ataxia,and the changes in Re Ho values suggest that the neuroactivity of cerebellar hemispheres and distant areas that are functionally connected to the cerebellum may be enhanced after r TMS treatment,and the specificmechanism of improving symptoms may be related to the cerebellar-thalamus-cerebral cortex loop.