| Background: Stroke is the second leading cause of human death.After stroke,patients will have different functional disorders,of which about 50% of stroke patients will have sensory impairment in the hand.Sensory impairment of hands have a great impact on the activities of daily living(ADL),placing a heavy burden on patients and families,and becoming an urgent problem to be solved.The current treatment of sensory impairment of hand is roughly divided into peripheral nerve stimulation and neuromodulation methods.Repetitive transcranial magnetic stimulation(rTMS),as a non-invasive central nerve regulation technology,has been gradually popularized in clinic.Its mechanism is mainly to balance both hemispheres of the brain and strengthen the internal functional connection of brain tissue,so as to improve the function of patients after stroke.The posterior central gyrus is the functional area of the central cortex in the sensory conduction pathway,that is,the primary somatosensory cortex(S1);The posterior parietal cortex(PPC)is closely related to the S1 area and the primary motor cortex(M1),which is a sensory motor integration area.In the early stage of brain injury,brain protection and nerve remodeling are in a critical period.At this time,rTMS treatment is the best way to promote nerve recovery.Purpose: In this study,a circular coil was used to give a high-frequency stimulation of 5Hz at the midpoint of the stroke-side hemisphere S1 and PPC regions of the early stroke subjects,and the somatosensory evoked potential(SEP),current perception threshold(CPT),and Semmes-Weinstein monofilament test(SWMT),sensory impairment score were observed on the affected side.Based on the concept of sensorimotor integration,the influence on motor indicators was observed,such as the Fugl-Meyer assessment of the upper limb(FMA-UL),and the motor evoked potential(MEP).Through the above observations,it is verified whether this study has clinical application and promotion significance.Method: 29 subjects who met the inclusion criteria were selected,including 22 males and 7 females.There were 16 persons in rTMS group,including 13 males and 3females;There were 13 subjects in the sham stimulation group,including 9 males and4 females.The rTMS group performed high-frequency rTMS stimulation and routine rehabilitation,and the sham-stimulation group performed empty coil shamstimulation and routine rehabilitation.rTMS parameters: 5Hz;80%-120% RMT;10pulses per sequence,the duration is 2s,the sequence interval is 5s;a total of 100 sequences,1000 pulses;the treatment time is 20 min.All treatments are once a day,5days a week,4 weeks.Subjects were assessed by SEP,CPT,SMWT,sensory impairment score,MEP,FMA-UL before and after treatment.Outcome:(1)SEP comparison: In rTMS group,N20,n20-p25 and p15-p25 were 21.27 ±2.38ms?3.58 ± 2.32?V ?9.05 ± 2.87 ms respectively before treatment and 19.18 ±1.92ms? 4.52 ± 2.24?V ?6.97 ± 2.76 ms respectively after treatment(P < 0.05);The effect of rTMS group was better than that of sham stimulation group(P < 0.05).(2)CPT comparison: There were significant differences in CPT at 2000 Hz,250Hz and 5Hz before and after treatment in rTMS group(P < 0.05);After treatment,the effect of rTMS group on CPT was better than that of sham stimulation group(P <0.05).(3)Comparison of SMWT thresholds: The SMWT scores of rTMS group and sham stimulation group were significantly different before and after treatment(P <0.05),and the effect of rTMS group was significantly better than that of sham stimulation group(P < 0.05).(4)Comparison of sensory impairment scores: There was significant difference in the scores of sensory disturbance between rTMS group and sham stimulation group before and after treatment(P<0.05).(5)Comparison of MEP incidence rates: The number of MEP patients in rTMS group increased by 4 after treatment;After treatment,the number of MEP patients in the sham stimulation group increased by 1 person.(6)Comparison of FMA-UL scores: The FMA-UL scores of rTMS group and sham stimulation group were significantly different before and after treatment(P<0.05),and the improvement of upper limb motor function in rTMS group was significantly better than that in sham stimulation group(P<0.05).(7)Correlation analysis between sensory impairment scores and FMA-UL scores:There was a statistical difference in the association between sensory impairment scores and FMA-UL scores before treatment(r=0.435,P<0.05);after treatment,there was a statistical difference in the association between sensory impairment scores and FMA-UL scores(r=0.465,P<0.05).It shows a significant positive correlation between sensory function and motor function of the upper and hand after stroke.Conclusion: In this study,high-frequency rTMS was used to stimulate the S1 and PPC areas of the affected side,which has a positive significance for the central nervous system regulation and treatment of hand sensory disorders after stroke,and laid a foundation for clinical promotion.(1)High-frequency rTMS stimulation can significantly improve hand sensory function in patients with early stroke.(2)High-frequency rTMS stimulation improves corticospinal cord excitability and improves the motor function of the upper limbs and hands.(3)There was a significant positive correlation between sensory function of upper limb and hand and motor function after stroke. |
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