RTMS Combined With TDCS In The Treatment Of Memory Dysfunction After Stroke

Memory dysfunction after stroke seriously affects the quality of life and career outcomes of patients,and memory dysfunction is closely related to a variety of other dysfunction,which seriously affects patients' confidence in rehabilitation.At present,there are many rehabilitation methods for memory dysfunction after stroke,but the treatment cost is high and the treatment effect is limited.CNS based rehabilitation was significantly more effective than peripheral nerve therapy,and repeated Transcranial Magnetic Stimulation(rTMS),rTMS and transcranial Direct Current Stimulation(tDCS)are two effective,non-invasive,and less side effects central nervous regulation methods,which have been well used in the treatment of memory dysfunction after stroke.objective: This experiment mainly uses the rehabilitation intervention method of the combined application of rTMS and tDCS to perform rehabilitation intervention on the occurrence of memory dysfunction after stroke,and uses neuroelectrophysiological indicators,neuropsychological scales,and activities of daily living(Activity of daily living,ADL).Scale and other indicators to evaluate the treatment effect,analyze the correlation between neuroelectrophysiological indexes and neuropsychological scale evaluation,observe the therapeutic effect of the combined application of rTMS and tDCS in the treatment of memory dysfunction after stroke.The combined treatment of rTMS and tDCS for memory disorders provides evidence for inquiry.Methods: A total of 36 subjects were included in this study and randomly divided into control group(n=12),rTMS group(n=12),and rTMS combined with tDCS group(n=12).A total of 34 patients were finally completed in the experiment,among which 2 patients were shed in the rTMS combined with tDCS group.Subjects in all three groups received intervention training for 4 weeks and were evaluated before and after the intervention.The control group received conventional treatment only,the rTMS group received conventional treatment and rTMS treatment,and the rTMS combined with tDCS group received conventional treatment,rTMS and tDCS combined treatment.Routine treatment includes:(1)drug therapy.(2)Memory function training(such as visual memory,immediate memory,delayed memory,picture memory,prospective memory,spatial memory,spatio-temporal orientation,date memory,etc.).In order to obtain the best therapeutic effect,the routine memory function training of the subjects in the rTMS group was started after rTMS treatment,and the memory function training of the subjects in the rTMS combined with tDCS treatment was conducted after rTMS combined with tDCS treatment.Memory function training was performed for 30 minutes once a day,five days a week,for four weeks.(3)Physical exercise rehabilitation treatment(mainly based on Bobath technology,Brunnstrom technology,PNF technology,sports relearning technology and other means as the treatment of neurophysiological development therapy technology treatment),each treatment for 60 minutes,once a day,five days a week,a total of four weeks.(4)ADL training,a total of 30 minutes each time,once a day,five days a week,a total of four weeks.(5)rTMS treatment methods:The initial stimulus intensity was 80% Relaxed Motor Threshold(RMT).Since the patient's tolerance gradually increased with the continuation of treatment,the intensity was adjusted according to the patient's tolerance at the beginning of the second,third and fourth week of treatment,with an intensity range of 80%-120%RMT.In the experiment,the left Dorsal Lateral Prefrontal Cortex(DLPFC)was selected as the stimulation site.According to the 10-20 international EEG record system,the "O" type dynamic air-cooling coil was placed at the subject's head point F3,and its central point was tangent and fitted to the surface of the patient's F3 point.High frequency 5Hz pulse magnetic stimulation was used for 1200 times of treatment,once a day,for a total of 20 minutes each time,five days a week,for a total of four weeks.(6)tDCS treatment method: refer to the international 10-20 electroencephalogram positioning system will be fixed in the affected side of the temporal lobe(T5/T6),the cathode placed in the healthy side of PPC(P3/P4),the current intensity is 1.2m A,20 minutes each time,once a day,five days a week,a total of four weeks.Results: Before the intervention and four weeks after the intervention,the neuroelectrophysiological index event-related potential P300,mismatch negativity(MMN)evaluation,and the neuropsychological scale Montreal Cognitive Assessment(Mo CA)Chinese Version,Rivermead Behavioral Memory Test(RBMT)and ADL scale modified Barthel Index(Modified Barthel Index,MBI)evaluation.1.After four weeks of intervention,the total scores of the MoCAscale and the scores of visual space and executive function of the control group,rTMS group and rTMS combined tDCS group of subjects were significantly increased.The delayed memory and abstraction scores of the rTMS group were significantly increased,and the delayed recall and abstraction scores of the rTMS combined tDCS group were significantly increased.(P<0.05);The total score and delayed recall score of the rTMS group were significantly higher than those of the control group,and the total score and delayed recall score of the rTMS combined tDCS group were higher than those of the rTMS group(P<0.05).It shows that the three intervention methods can improve the overall cognitive function of patients.The improvement effect of the rTMS combined tDCS group on the delayed recall item of the MoCAscale is better than that of the rTMS group.2.After four weeks of intervention,the total score of the RBMT scale,the orientation of time and space,and the score of the object in the rTMS group increased significantly.The total score of the RBMT scale of the rTMS combined with tDCS group,the object,the story(delayed recall),the orientation score of time and space,and the route(immediate The scores of treatment)and route(delayed treatment)were significantly increased(P<0.05);the scores of objects in the rTMS group were significantly higher than those in the control group,and the total score of RBMT,objects,routes(delayed treatment),and date in the rTMS combined tDCS group were significantly higher than those in the control group.The score was significantly increased,and the score of route delay treatment in the rTMS combined with tDCS group was significantly higher than that in the rTMS group(P<0.05).It shows that the rTMS combined with tDCS group can not only significantly improve the overall memory function of stroke patients,but also improve the delayed memory.3.After four weeks of intervention,the MMN latency of the control group,rTMS group and rTMS combined tDCS group of subjects were reduced,but there was no significant difference(P>0.05).The MMN latency of the rTMS group and the rTMS combined with tDCS group were significantly decreased(P<0.05);the rTMS group,rTMS combined with tDCS Compared with the control group,the MMN latency of the group was lower than that of the control group(P<0.05),and the latency of the rTMS combined tDCS group was lower than that of the rTMS group,but the difference was not statistically significant(P>0.05).It shows that both the rTMS group and the rTMS combined with tDCS group can reduce the MMN latency,but the rTMS combined with tDCS has no significant difference compared with the reduction of the rTMS latency.4.After four weeks of intervention,the P300 latency of the control group,rTMS group and rTMS combined tDCS group was significantly reduced,and the P300 amplitude of the rTMS group and rTMS combined with tDCS group was significantly increased(P<0.05);the P300 latency of the rTMS group,rTMS combined with tDCS group was lower than that of the control group,and the rTMS combined The P300 latency of the tDCS group was lower than that of the rTMS group(P<0.05),and there was no significant difference in the P300 amplitude between the groups after four weeks of intervention.It shows that the three intervention methods can reduce the P300 latency,rTMS,rTMS combined with tDCS can significantly increase the P300 amplitude,rTMS combined with tDCS is more effective in reducing the P300 latency than the simpler rTMS,but the effect is not significant in increasing the P300 amplitude.5.After four weeks of intervention,there was no significant difference in MBI of the control group(P>0.05).The MBI scores of the rTMS group and rTMS combined with tDCS group were significantly increased(P<0.05);the MBI scores of the rTMS group and rTMS combined with tDCS group were higher than those of the control group.But the difference was not statistically significant(P>0.05).It shows that rTMS,rTMS combined with tDCS can improve the ADL of patients,while the conventional rehabilitation training has no obvious effect on improving the ADL of patients with memory impairment after stroke.6.The MoCA and RBMT scores of the neuropsychological scales before and four weeks after the intervention were negatively correlated with neurophysiological indicators P300 and MMN latency,and positively correlated with the P300 amplitude,that is,the shorter the P300 latency,the greater the amplitude and the shorter the MMN latency.The higher the MoCAand RBMT scale scores,the better the patient's cognitive function and memory function.Conclusion: rTMS combined with tDCS treatment can effectively improve memory dysfunction after stroke.1.rTMS and rTMS combined with tDCS can improve the memory function of stroke patients by increasing the scores of MoCAscale and RBMT scale,reducing the latency of P300 and MMN,and increasing the amplitude of P300,and rTMS combined with tDCS has a more obvious effect on the memory function of stroke patients than rTMS.2.Compared with rTMS,rTMS combined with tDCS has a significant effect on delayed memory.Within 6 months after stroke,rTMS combined with tDCS can be used to treat delayed memory impairment after stroke.3.The neuropsychological scales MoCAand RBMT are negatively correlated with the incubation period of neuroelectrophysiological indicators P300 and MMN,and positively correlated with the P300 amplitude,but the neuro-electrophysiological evaluation is more sensitive than the neuropsychological scale evaluation.4.On the basis of conventional rehabilitation treatment plans,whether it is rTMS combined with tDCS or rTMS,both can increase the ADL of stroke patients and improve the standard of life and quality of stroke patients.5.The combination of rTMS and tDCS is safe and effective in treating patients with memory dysfunction after stroke.