高频经颅磁刺激可广泛改善脑卒中患者的工作记忆和认知症状:随机对照试验

Neurorehabilitation and neural repair Pub Date : 2024-10-01 Epub Date: 2024-08-20 DOI:10.1177/15459683241270022
Yuanwen Liu, Yinan Ai, Jie Cao, Qilin Cheng, Hongwu Hu, Jing Luo, Lei Zeng, Shuxian Zhang, Jie Fang, Li Huang, Haiqing Zheng, Xiquan Hu
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摘要

目的探讨高频重复经颅磁刺激(rTMS)治疗脑卒中后工作记忆(WM)障碍的疗效、耐受性及其对脑功能的影响:在本随机、双盲、假对照设计中,对脑卒中后工作记忆障碍患者的左侧背外侧前额叶皮层(DLPFC)进行为期14天的10赫兹经颅磁刺激。测量包括 WM(主要结果)、综合神经心理测试和功能性近红外光谱测试。分别在基线、干预后(第2周)和治疗停止后4周(第6周)对患者进行评估:结果:在 123 名中风患者中,82 人完成了试验。经颅磁刺激组在第 2 周的 WM 改善程度(t = 5.55,P t = 2.11,P = .045)高于假治疗组。经颅磁刺激组的大部分神经心理测试成绩都有明显改善。尤其是在第2周和第6周时,经颅磁刺激组的氧合血红蛋白含量明显提高,左侧DLPFC、右侧运动前皮层(PMC)和右侧顶叶上部(SPL)的功能连接性明显增强。辍学率相同(各组均为18% [9/50例]),头痛是最常见的副作用(经颅磁刺激:36% [18/50例];假性经颅磁刺激:30% [15/50例]):结论:高频经颅磁刺激能有效改善卒中后的WM损伤,且耐受性良好,疗效可持续4周,这可能是由于激活了左侧DLPFC、右侧PMC和右侧SPL脑区,并协同促进了神经重塑。
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High-Frequency rTMS Broadly Ameliorates Working Memory and Cognitive Symptoms in Stroke Patients: A Randomized Controlled Trial.

Objective: To explore the efficacy and tolerability of high-frequency repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke working memory (WM) impairment and its changes in brain function.

Methods: In the present randomized, double-blinded, sham-controlled design, 10 Hz rTMS was administered to the left dorsolateral prefrontal cortex (DLPFC) of patients with post-stroke WM impairment for 14 days. Measures included WM (primary outcome), comprehensive neuropsychological tests, and the functional near-infrared spectroscopy test. Patients were assessed at baseline, after the intervention (week 2), and 4 weeks after treatment cessation (week 6).

Results: Of 123 stroke patients, 82 finished the trial. The rTMS group showed more WM improvement at week 2 (t = 5.55, P < .001) and week 6 (t = 2.11, P = .045) than the sham group. Most of the neuropsychological test scores were markedly improved in the rTMS group. In particular, the rTMS group exhibited significantly higher oxygenated hemoglobin content and significantly stronger functional connectivity in the left DLPFC, right pre-motor cortex (PMC), and right superior parietal lobule (SPL) at weeks 2 and 6. Dropout rates were equal (18% [9/50 cases] in each group), and headaches were the most common side effect (rTMS: 36% [18/50 cases]; sham: 30% [15/50 cases]).

Conclusions: High-frequency rTMS was effective in improving post-stroke WM impairment, with good tolerability, and the efficacy lasted up to 4 weeks, which may be due to the activation of the left DLPFC, right PMC, and right SPL brain regions and their synergistic enhancement of neural remodeling.

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