Yuanwen Liu, Yinan Ai, Jie Cao, Qilin Cheng, Hongwu Hu, Jing Luo, Lei Zeng, Shuxian Zhang, Jie Fang, Li Huang, Haiqing Zheng, Xiquan Hu
{"title":"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","authors":"Yuanwen Liu, Yinan Ai, Jie Cao, Qilin Cheng, Hongwu Hu, Jing Luo, Lei Zeng, Shuxian Zhang, Jie Fang, Li Huang, Haiqing Zheng, Xiquan Hu","doi":"10.1177/15459683241270022","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>Of 123 stroke patients, 82 finished the trial. The rTMS group showed more WM improvement at week 2 (<i>t</i> = 5.55, <i>P</i> < .001) and week 6 (<i>t</i> = 2.11, <i>P</i> = .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]).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"729-741"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528952/pdf/","citationCount":"0","resultStr":"{\"title\":\"High-Frequency rTMS Broadly Ameliorates Working Memory and Cognitive Symptoms in Stroke Patients: A Randomized Controlled Trial.\",\"authors\":\"Yuanwen Liu, Yinan Ai, Jie Cao, Qilin Cheng, Hongwu Hu, Jing Luo, Lei Zeng, Shuxian Zhang, Jie Fang, Li Huang, Haiqing Zheng, Xiquan Hu\",\"doi\":\"10.1177/15459683241270022\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>Of 123 stroke patients, 82 finished the trial. The rTMS group showed more WM improvement at week 2 (<i>t</i> = 5.55, <i>P</i> < .001) and week 6 (<i>t</i> = 2.11, <i>P</i> = .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]).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":94158,\"journal\":{\"name\":\"Neurorehabilitation and neural repair\",\"volume\":\" \",\"pages\":\"729-741\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528952/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurorehabilitation and neural repair\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/15459683241270022\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurorehabilitation and neural repair","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15459683241270022","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/20 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
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.