Effect Of Repetitive Transcranial Magnetic Stimulation For Upper Extremity Dysfunction After Stroke

Objective:1.The meta-analysis evaluated the effectiveness and safety of repetitive transcranial magnetic stimulation on upper limb function after stroke through various aspects.2.There are few studies on the combination of low-frequency repetitive transcranial magnetic stimulation and high-frequency repetitive transcranial magnetic stimulation to treat upper limb function after stroke.This study explored the efficacy and safety of the combination of low-frequency repetitive transcranial magnetic stimulation and high-frequency repetitive transcranial magnetic stimulation on upper limb function after stroke.Methods:1.Search for relevant research published in English journals.The scope of the search includes English language databases such as Pub Med,the Cochrane library,and the Web of Science.The Pub Med and Cochrane library searches started and ended with the establishment of the database through January 2021,and the Web of Science searches from 1950 to January 2021.All searches included randomized controlled or randomized cross-trials of repetitive transcranial magnetic stimulation,stroke,upper limb function,etc.The two researchers searched respectively according to the retrieval strategy,scope and time,and evaluated the study quality after screening the study.Relevant data were extracted from the included literature,and finally using the Review Manager5.3 software and Stata13.0 software for Meta analysis.2.The study included 10 stroke patients who met the criteria and were randomly divided into a test group and a control group.In the experimental group,patients were given low frequency1 Hz repetitive transcranial magnetic stimulation for the contralateral motor cortex area for the first 10 treatments,and the last 10 treatments were given high frequency 10 Hz repetitive transcranial magnetic stimulation.The primary motor cortex area on the side received a total of 20 treatments.After treatment,conventional rehabilitation and medication were used.The control group only used conventional rehabilitation and medication.The Brunnstrom stage sum of the upper extremity and hand was assessed before and after treatment,doctorusethe modified Ashworth scale assessingthe flexor carpalis and elbow flexor muscle tone,and usethe Fugl-Meyer upper extremity partial rating scaleto assess motor function.Statistical analysis was performed to compare the therapeutic effect between the experimental group and the control group.Results: 1.Eleven randomized controlled orcrosstrials,including 444 patients,were finally included.Compared with the control group,the results of Meta analysis indicated that,repetitive transcranial magnetic stimulation can improve the Fugl-Meyer motor function rating scale score(MD=5.06,95%CI[2.39,7.73],P=0.0002)and Barthel Index or modified Barthel index score(MD=8.47,95%CI[1.59,15.35],P=0.02),reduce upper limb modified Ashworth scale score(MD=-0.70,95%CI[-0.79,-0.60],P<0.00001),the incubation period of motor evoked potentials of the contralateral motor cortex was unchanged(MD=0.99,95%CI[-0.23,2.21],P=0.11).There was no statistically significant incidence of adverse events during and after repetitive transcranial magnetic stimulation for upper limb dysfunction after stroke(MD=1.38,95%CI[0.44,4.36],P=0.58).2.Compared with the control group,after treatment,the Brunnstrom staging of the upper extremity and hand and the Fugl-Meyer upper limb part evaluation scale scores of the patients in the test group increased,which was statistically significant(P<0.05);but the modified Ashworth scale scores of the wrist and elbow flexors The reduction and improvement were not significant,and no significant statistical significance was seen(P=0.19).In the experimental group,Before and after treatment,Brunnstrom’s upper limb and hand staging and upper limb Fugl-Meyer motor function were significantly improved(P<0.05),and the modified Ashworth scale scores of the wrist and elbow flexors were reduced.This is statistically significant.In the control group,the Fugl-Meyer upper limb motor function rating scale score increased significantly before and after treatment,which was statistically significant(P<0.05).Conclusions: 1.Simple repetitive transcranial magnetic stimulation mode and theta burst stimulation mode can improve the recovery of upper limb motor function after stroke.Repetitive transcranial magnetic stimulation can improve the ability of daily living of patients with stroke,but the effect of improving upper limb spasm after stroke is uncertain.Repetitive transcranial magnetic stimulation is safe for patients with upper limb dysfunction after stroke,and no serious adverse events have been seen.2.The combination of low-frequency and high-frequency repetitive transcranial magnetic stimulation can effectively improve the motor function of the upper limbs after stroke,but there is no significant difference in the improvement of spasticity.The clinical safety of the combined program of repetitive transcranial magnetic stimulation is relatively good.