Effects Of Repetitive Transcranial Magnetic Stimulation Over Primary Motor Cortex At Different Frequencies On Lower Limb Dyskinesia In Patients After Massive Cerebral Infarction

Objective To observe and evaluate the therapeutic effects of different frequencies repetitive transcranial magnetic stimulation(rTMS)in contralateral cortex on lower limb dyskinesia in patients with massive cerebral infarction(MCI),and to charify the primary mechanism of them.Methods 50 MCI patients diagnosed with functional activity of unilateral lower limb dyskinesia were selected and randomly divided into high frequency(HF-)rTMS group(n=17),low frequency(LF-)rTMS group(n=17)and sham(S-)rTMS group(n=16).All patients were given cognitive routine drugs and rehabilitation training every day.On this basis of the above drugs and training,rTMS or sham stimulation with different frequencies were applied to the primary motor cortex(M1 region)of the contralateral hemisphere.The HF-group received 10 Hz rTMS,the LF-group received 1 Hz rTMS,and the S-group received sham rTMS.The stimulation intensity was 80% of the resting motor threshold(RMT),5 sessions per week and a total of 3 weeks.In this study,the patients in three groups were scored once before the first treatment or sham rTMS,and then scored again immediately after 3 weeks of treatment.The lower extremity of Fugl-Meyer scale(FMALE),Modified Barthel Index(MBI),Functional Ambulation Classification(FAC),Berg Balance Scale(BBS),cortical latencies of motor evoked potentials(MEP)were evaluated,The infarct volume and fractional anisotropy(FA)of the infarct and corpus callosum on diffusion tensor imaging(DTI)were collected,and the statistical data were analyzed by relevant statistical software.Results 1.Case inclusion and completion: A total of 50 patients were included in this study,including 5 cases falling off and 45 patients completed this study,The total abscission rate was 1.00% in 45 cases,including 2 cases in the HF-group,2 cases in the LF-group and1 case in the S-group.2.General situation: Before receiving treatment,there was no marked difference between all groups in terms of age,gender,onset time,infarct side,infarct volume(P > 0.05),which showed comparability.3.Results of relevant indicators: There was no marked difference in FMA-LE,MBI,FAC,BBS,MEP and FA value among the three groups before treatment(P > 0.05).Immediately after treatment compared with before treatment,FMA-LE,MBI,FAC,BBS of three groups were significantly higher after 3 weeks of treatment(P < 0.05),MEP cortical latency was significantly shortened(P < 0.05),FA value of corpus callosum was increased(P < 0.05),but FA value of infarct had no significant change(P > 0.05).The FMA-LE,MBI,FAC,BBS,MEP cortical latency and FA value of corpus callosum in HF-group is better than that of LF-group and S-group(P < 0.05),but there was no marked difference between the LFgroup and the S-group(P > 0.05).4.Safety evaluation: In this study,only two patients in the three groups had local skin burning during the treatment of false stimulation or rTMS stimulation,which was relieved after rest without other obvious adverse reactions.Conclusion HF-rTMS on M1 region of contralateral hemisphere combined with conventional rehabilitation training is a new treatment method,which can promote the recovery of lower limb motor function in MCI patients,and its curative effect is better than LF-rTMS and S-rTMS.