Effects Of RTMS Combined With EMGBFT Therapy On Lower Limb Spasm And Motor Function In Subacute Ischemic Stroke Patients

Objective:To investigate the effects of low frequency(1HZ),high frequency(10HZ)r TMS combined with EMGBFT on lower limb spasm and motor function in subacute ischemic stroke patients.Methods:A total of 105 patients with subacute cerebral infarction were recruited from the department of neurology and rehabilitation,Union hospital of Fujian medical university between January 2018 and December 2018.They were randomly assigned into 4 groups: sham stimulation group(sham group,n=25),low-frequency stimulation combined with EMGBFT group(low frequency group,n=26),high-frequency stimulation combined with EMGBFT group(high frequency group,n=26),low-frequency stimulation and highfrequency stimulation combined with EMGBFT group(low and high frequency group,n=26).Patients in each group received EMGBFT besides routine medication,physical therapy and occupational therapy.Before and after combined r TMS and EMGBFT treatment,the patients were assessed with simple Fugl-Meyer assessment(FMA),modified Ashworth scale(MAS),modified Barthel index(MBI),Postural Assessment Scale for Stroke Patients(PASS),Berg balance scale and motor evoked potential(MEP).The independent gait was assessed with functional ambulation categories scale at 3 months flow-up after ischemic stroke onset.The predictive value of timing and different mode of r TMS for the independent gait at short term follow-up were analyzed using a multivariate logistic regression model.Results:1.Following 4 weeks' treatment,considerable improvement was found in the FMA score,MBI score,PASS score and Berg score in 4 groups,respectively(P<0.01).In comparison with sham group,significantly higher values were revealed in the FMA score,MBI score,PASS score and Berg score in low-frequency group,high-frequency group,low and highfrequency group,respectively(P<0.001).It was also found that low-frequency group exhibited significantly higher values in the FMA score,MBI score,PASS score and Berg score than high frequency group and the low frequency + high frequency group,respectively(P<0.01);On the other hand,no significant difference was found between high frequency group and low + high frequency group in the FMA score,MBI score,PASS score and Berg score,respectively(P>0.05).2.In each group,significantly lower value was found in the MAS score and MEP latency of the affected side of sham group after than before the treatment,respectively(P<0.01).When compared with sham group,significantly lower value in the MAS score and MEP latency of the affected side was found in low-frequency group,high-frequency group,low and high-frequency group,respectively(P<0.001).Low-frequency group has significantly lower value in the MAS score and MEP latency of the affected side in high frequency group and the low frequency + high frequency group,respectively(P<0.01);However,there was no significant difference in the MAS score and MEP latency of the affected side between high frequency group and low + high frequency group(P>0.05).3.In multivariate logistic regression analysis,late timing of r TMS(OR 0.91 95%CI 0.83-0.99,P=0.034)was an independent risk factor for the independent gait at 3 months follow-up after ischemic stroke.Different r TMS mode was not associated with independent gait at 3 months follow-up(p=0.078).4.Within four groups,no significant difference was observed in the very low incidence of adverse events(P>0.05).Conclusion:Our results suggested that low-frequency r TMS combined with EMGBFT,high-frequency r TMS combined with EMGBFT and low-frequency plus high-frequency r TMS combined with EMGBFT can significantly improve lower extremity spasm and motor function in patients with subacute ischemic stroke.Low and high frequency r TMS combined with EMGBFT may be more effective in the rehabilition of lower extremity motor function and spasm in patients with subacute ischemic stroke than low-frequency r TMS combined with EMGBFT or high-frequency r TMS combined with EMGBFT.Different r TMS mode was not associated with independent gait at 3 months follow-up after ischemic stroke.