| Objective Repetitive transcranial magnetic stimulation,as a non-invasive method of brain stimulation,can be used as a treatment to improve the motor function after stroke,but there are few researches on patients with chronic recovery.In this study,the subjects were randomly divided into two groups: repetitive transcranial magnetic stimulation group and sham stimulation group.The changes of neuroelectrophysiological indexes of the two groups before and after the intervention and the changes of the upper limb function evaluation scale before and after the intervention were compared to explore the effect of high frequency repetitive transcranial magnetic stimulation on the upper limb function of patients with chronic stroke.Method: 18 patients(stroke time > 3 months)who received rehabilitation treatment from Rehabilitation Department of Huadong Hospital affiliated to Fudan University in 2018-2019 were randomly assigned to the experimental group and the control group.Nine patients in the control group received conventional rehabilitation therapy and transcranial magnetic stimulation,including manipulation therapy,physical factor therapy,speech therapy and occupational therapy.Nine patients in the experimental group received repeated transcranial magnetic stimulation on the basis of conventional treatment.The stimulation waveform was biphasic waveform.The stimulation frequency was 10 Hz,and the stimulation site was motor cortex area of the affected side.The stimulation intensity was 90% of the patient’s resting motion threshold.The number of stimulation strings was 20.The number of stimulation pulses per string was 50.The interval time of the strings was 55 s,and the total number of pulses was 10.The duration of stimulation was 20 minutes.RTMS was used for two weeks(Monday to Friday).The sham stimulation method used in the control group was that the coil was placed in the opposite direction of the experimental group,and placebo intervention was conducted in the contralateral cerebral hemisphere with the same stimulation parameters as the experimental group.Before and after stimulation,the conduction of corticospinal tract,cortical excitability,upper extremity function scale,activity of daily living and fine function of hand were assessed.Spss22.0 was used for statistical analysis.Descriptive statistical analysis and chi square test were used for general data.Paired sample t test was used for intra group difference comparison,and independent sample t test was used for inter group difference.P < 0.05 showed significant difference.Result: 1.Conduction of corticospinal tract The evaluation indexes included motor evoked potential and central conduction time.There was no significant difference in MEP amplitude between the experimental group and the control group before and after stimulation(P>0.05).The latency of MEP in the experimental group was significantly shorter than that in the control group (P < 0.05).There was no significant difference in central conduction time between the experimental group and the control group before and after stimulation(P>0.05).2.Cortical excitability The evaluation indexes included resting motor threshold and resting period of cortex.The resting motor threshold of the affected cortex in the experimental group was significantly lower than that before stimulation(P<0.05),and the difference of the affected cortex in the experimental group was significantly lower than that in the control group(P<0.05).The resting period of the affected cortex in the experimental group was significantly lower than that before stimulation(P<0.05),and the difference of the affected cortex in the experimental group was significantly different than that in the control group(P<0.05)3.Functional evaluation of upper extremity The evaluation indexes included the upper extremity part of Fugl-Meyer scale,Barthel index,grip strength and nine hole column test.The results showed that the scores of Fugl-Meyer in the two groups after stimulation were significantly higher than those before stimulation,and the scores in the experimental group before and after stimulation were significantly higher than those in the control group(P<0.05).The scores of Barthel Index in the experimental group and the control group before and after stimulation were not significantly different within and between the groups(P>0.05).The differences in the grip strength of the affected side in the experimental group before and after stimulation were significant(P<0.05).After stimulation,the grip strength of the affected side in the experimental group was significantly improved compared with that in the control group(P<0.05).The time difference of the affected side in the experimental group after stimulation was significantly shorter than that before stimulation(P<0.05),and the time difference of the affected side in the experimental group after stimulation was significantly shorter than that in the control group(P<0.05).Conclusion: 1.Two weeks high frequency r TMS treatment may not significantly improve the conduction of corticospinal tract in patients with chronic stroke.2.Two weeks high frequency r TMS treatment can enhance the excitability of the affected cortex in patients with chronic stroke.3.Two weeks high-frequency r TMS stimulation may improve the fine function of the hand,but the treatment time is short,which can not significantly improve the ability of daily life. |
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