Effect of transcranial combined with peripheral repetitive magnetic stimulation on motor function after stroke_West China Medical Journal

Authors：

YAN Jingjing , YUAN Haifeng , ZHANG Ni , ZAHNG Hui , FU Jing , XU Tian ,  ZHANG Qiaojun

Department of Rehabilitation Medicine, the Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi 710004, P. R. China;

Corresponding author：

ZHANG Qiaojun, Email: zhangqj@mail.xjtu.edu.cn

Keywords：

Repetitive transcranial magnetic stimulation; Repetitive peripheral magnetic stimulation; Stroke; Motor dysfunction

DOI：

10.7507/1002-0179.202103206

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Objective To investigate the efficacy of transcranial combined with peripheral repetitive magnetic stimulation on motor dysfunction after stroke.Methods A total of 40 patients after stroke who were hospitalized in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Xi’an Jiaotong University between January and December 2019 were selected. The patients were divided into the trial group and the control group by random number table method, with 20 cases in each group. Both groups received conventional rehabilitation and medicine treatment, on that basis, the trial group received repetitive transcranial magnetic stimulation (rTMS) combined with repetitive peripheral magnetic stimulation (rPMS), while the control group received rTMS combined with fake rPMS, both lasted for 2 weeks. Before treatment and 2, 4, 12 weeks after the initiation of treatment, the Fugl-Meyer Assessment (FMA) [including FMA-Upper Limb (FMA-UL), FMA-Lower Limb (FMA-LL)], National Institute of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI) were used to evaluate the efficacy of rTMS combined with rPMS.Results Five patients fell off, and 35 patients were finally included, including 18 in the trial group and 17 in the control group. No adverse reaction occurred during the study. Before treatment, there was no significant difference in FMA, FMA-UL, FMA-LL, NIHSS or MBI scores between the two groups (P>0.05). After treatment, the FMA score of the trial group changed from 36.44±28.59 to 75.56±19.94, and that of the control group changed from 39.05±29.85 to 54.64±23.25; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-UL score of the trial group changed from 21.39±22.14 to 46.94±15.84, and that of the control group changed from 20.82±20.47 to 31.29±16.98; the between-group difference was statistically significant at the end of the 4th and 12th weeks (P<0.05). The FMA-LL score of the trial group changed from 15.06±9.10 to 28.61±5.69, and that of the control group changed from 18.23±10.33 to 23.35±8.20; the between-group difference was statistically significant at the end of the 12th week (P>0.05). The NIHSS score of the trial group changed from 6.83±4.54 to 2.78±2.05, and that of the control group changed from 6.35±3.67 to 3.94±2.56; the MBI score of the trial group changed from 53.33±17.90 to 83.06±12.50, and that of the control group changed from 60.88±25.45 to 78.82±15.67; there was no statistically significant difference in NIHSS or MBI between the two groups at any timepoint (P>0.05). Except for the FMA-LL of the control group, the other outcome indicators in each group were significantly different after treatment compared with those before treatment (P<0.05).Conclusions Both rTMS and rTMS combined with rPMS can improve the limb motor function and activities of daily living of stroke patients. The treatment mode of rTMS combined with rPMS has better effect on motor dysfunction after stroke, which is of great significance for improving the overall rehabilitation effect.

Citation： YAN Jingjing, YUAN Haifeng, ZHANG Ni, ZAHNG Hui, FU Jing, XU Tian, ZHANG Qiaojun. Effect of transcranial combined with peripheral repetitive magnetic stimulation on motor function after stroke. West China Medical Journal, 2021, 36(5): 588-594. doi: 10.7507/1002-0179.202103206 Copy

1.	Feigin VL, Norrving B, Mensah GA, et al. Global burden of stroke. Circ Res, 2017, 120(3): 439-448.
2.	Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res, 2016, 118(9): 1340-1347.
3.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
4.	张薇, 范宇威, 高静, 等. 脑卒中流行病学调查相关文献复习. 中国临床神经科学, 2014(6): 699-703.
5.	中华医学会神经病学分会, 中华医学会神经病学分会神经康复学组, 中华医学会神经病学分会脑血管病学组. 中国脑卒中早期康复治疗指南. 中华神经科杂志, 2017, 50(6): 405-412.
6.	Lefaucheur JP, Aleman A, Baeken C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018). Clin Neurophysiol, 2020, 131(2): 474-528.
7.	Schuhfried O, Crevenna R, Fialka-Moser V, et al. Non-invasive neuromuscular electrical stimulation in patients with central nervous system lesions: an educational review. J Rehabil Med, 2012, 44(2): 99-105.
8.	Beaulieu LD, Schneider C. Repetitive peripheral magnetic stimulation to reduce pain or improve sensorimotor impairments: a literature review on parameters of application and afferents recruitment. Neurophysiol Clin, 2015, 45(3): 223-237.
9.	Chen S, Li Y, Shu X, et al. Electroencephalography mu rhythm changes and decreased spasticity after repetitive peripheral magnetic stimulation in patients following stroke. Front Neurol, 2020, 11: 11546599.
10.	Malejko K, Huss A, Schonfeldt-Lecuona C, et al. Emotional components of pain perception in borderline personality disorder and major depression: a repetitive peripheral magnetic stimulation (rPMS) study. Brain Sci, 2020, 10(12): 905.
11.	Zschorlich VR, Hillebrecht M, Tanjour T, et al. Repetitive peripheral magnetic nerve stimulation (rPMS) as adjuvant therapy reduces skeletal muscle reflex activity. Front Neurol, 2019, 10: 930.
12.	Khedr EM, Ahmed MA, Alkady EA, et al. Therapeutic effects of peripheral magnetic stimulation on traumatic brachial plexopathy: clinical and neurophysiological study. Neurophysiol Clin, 2012, 42(3): 111-118.
13.	贾杰. “中枢-外周-中枢”闭环康复—脑卒中后手功能康复新理念. 中国康复医学杂志, 2016, 31(11): 1180-1182.
14.	Guan YZ, Li J, Zhang XW, et al. Effectiveness of repetitive transcranial magnetic stimulation (rTMS) after acute stroke: a one-year longitudinal randomized trial. CNS Neurosci Ther, 2017, 23(12): 940-946.
15.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点 2019. 中华神经科杂志, 2019, 52(9): 710-715.
16.	李晓松, 陈峰, 郝元涛, 等. 卫生统计学. 8 版. 北京: 人民卫生出版社, 2017: 423.
17.	Fugl-Meyer AR, Jääskö L, Leyman I, et al. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med, 1975, 7(1): 13-31.
18.	Fugl-Meyer AR. Post-stroke hemiplegia assessment of physical properties. Scand J Rehabil Med Suppl, 1980, 7: 85-93.
19.	Asplund K. Clinimetrics in stroke research. Stroke, 1987, 18(2): 528-530.
20.	Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother, 2014, 60(1): 61.
21.	Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 1989, 42(8): 703-709.
22.	Khan FR, Chevidikunnan MF. Effectiveness of central plus peripheral stimulation (CPPS) on post stroke upper limb motor rehabilitation. Brain Inj, 2017, 31(11): 1494-1500.
23.	Kubis N. Non-invasive brain stimulation to enhance post-stroke recovery. Front Neural Circuits, 2016, 10: 56.
24.	Grefkes C, Fink GR. Reorganization of cerebral networks after stroke: new insights from neuroimaging with connectivity approaches. Brain, 2011, 134(Pt 5): 1264-1276.
25.	Khedr EM, Fetoh NA. Short- and long-term effect of rTMS on motor function recovery after ischemic stroke. Restor Neurol Neurosci, 2010, 28(4): 545-559.
26.	McGirr A, van den Eynde F, Tovar-Perdomo S, et al. Effectiveness and acceptability of accelerated repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depressive disorder: an open label trial. J Affect Disord, 2015, 173: 216-220.
27.	Naro A, Russo M, Leo A, et al. A single session of repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex in patients with unresponsive wakefulness syndrome: preliminary results. Neurorehabil Neural Repair, 2015, 29(7): 603-613.
28.	Krewer C, Hartl S, Muller F, et al. Effects of repetitive peripheral magnetic stimulation on upper-limb spasticity and impairment in patients with spastic hemiparesis: a randomized, double-blind, sham-controlled study. Arch Phys Med Rehabil, 2014, 95(6): 1039-1047.
29.	Stultz DJ, Osburn S, Burns T, et al. Transcranial magnetic stimulation (TMS) safety with respect to seizures: a literature review. Neuropsychiatr Dis Treat, 2020, 16: 2989-3000.
30.	Beaulieu LD, Schneider C. Effects of repetitive peripheral magnetic stimulation on normal or impaired motor control. A review. Neurophysiol Clin, 2013, 43(4): 251-260.
31.	Chavez LM, Huang SS, MacDonald I, et al. Mechanisms of acupuncture therapy in ischemic stroke rehabilitation: a literature review of basic studies. Int J Mol Sci, 2017, 18(11): 2270.

1. Feigin VL, Norrving B, Mensah GA, et al. Global burden of stroke. Circ Res, 2017, 120(3): 439-448.
2. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res, 2016, 118(9): 1340-1347.
3. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
4. 张薇, 范宇威, 高静, 等. 脑卒中流行病学调查相关文献复习. 中国临床神经科学, 2014(6): 699-703.
5. 中华医学会神经病学分会, 中华医学会神经病学分会神经康复学组, 中华医学会神经病学分会脑血管病学组. 中国脑卒中早期康复治疗指南. 中华神经科杂志, 2017, 50(6): 405-412.
6. Lefaucheur JP, Aleman A, Baeken C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018). Clin Neurophysiol, 2020, 131(2): 474-528.
7. Schuhfried O, Crevenna R, Fialka-Moser V, et al. Non-invasive neuromuscular electrical stimulation in patients with central nervous system lesions: an educational review. J Rehabil Med, 2012, 44(2): 99-105.
8. Beaulieu LD, Schneider C. Repetitive peripheral magnetic stimulation to reduce pain or improve sensorimotor impairments: a literature review on parameters of application and afferents recruitment. Neurophysiol Clin, 2015, 45(3): 223-237.
9. Chen S, Li Y, Shu X, et al. Electroencephalography mu rhythm changes and decreased spasticity after repetitive peripheral magnetic stimulation in patients following stroke. Front Neurol, 2020, 11: 11546599.
10. Malejko K, Huss A, Schonfeldt-Lecuona C, et al. Emotional components of pain perception in borderline personality disorder and major depression: a repetitive peripheral magnetic stimulation (rPMS) study. Brain Sci, 2020, 10(12): 905.
11. Zschorlich VR, Hillebrecht M, Tanjour T, et al. Repetitive peripheral magnetic nerve stimulation (rPMS) as adjuvant therapy reduces skeletal muscle reflex activity. Front Neurol, 2019, 10: 930.
12. Khedr EM, Ahmed MA, Alkady EA, et al. Therapeutic effects of peripheral magnetic stimulation on traumatic brachial plexopathy: clinical and neurophysiological study. Neurophysiol Clin, 2012, 42(3): 111-118.
13. 贾杰. “中枢-外周-中枢”闭环康复—脑卒中后手功能康复新理念. 中国康复医学杂志, 2016, 31(11): 1180-1182.
14. Guan YZ, Li J, Zhang XW, et al. Effectiveness of repetitive transcranial magnetic stimulation (rTMS) after acute stroke: a one-year longitudinal randomized trial. CNS Neurosci Ther, 2017, 23(12): 940-946.
15. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点 2019. 中华神经科杂志, 2019, 52(9): 710-715.
16. 李晓松, 陈峰, 郝元涛, 等. 卫生统计学. 8 版. 北京: 人民卫生出版社, 2017: 423.
17. Fugl-Meyer AR, Jääskö L, Leyman I, et al. The post-stroke hemiplegic patient. 1. A method for evaluation of physical performance. Scand J Rehabil Med, 1975, 7(1): 13-31.
18. Fugl-Meyer AR. Post-stroke hemiplegia assessment of physical properties. Scand J Rehabil Med Suppl, 1980, 7: 85-93.
19. Asplund K. Clinimetrics in stroke research. Stroke, 1987, 18(2): 528-530.
20. Kwah LK, Diong J. National Institutes of Health Stroke Scale (NIHSS). J Physiother, 2014, 60(1): 61.
21. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol, 1989, 42(8): 703-709.
22. Khan FR, Chevidikunnan MF. Effectiveness of central plus peripheral stimulation (CPPS) on post stroke upper limb motor rehabilitation. Brain Inj, 2017, 31(11): 1494-1500.
23. Kubis N. Non-invasive brain stimulation to enhance post-stroke recovery. Front Neural Circuits, 2016, 10: 56.
24. Grefkes C, Fink GR. Reorganization of cerebral networks after stroke: new insights from neuroimaging with connectivity approaches. Brain, 2011, 134(Pt 5): 1264-1276.
25. Khedr EM, Fetoh NA. Short- and long-term effect of rTMS on motor function recovery after ischemic stroke. Restor Neurol Neurosci, 2010, 28(4): 545-559.
26. McGirr A, van den Eynde F, Tovar-Perdomo S, et al. Effectiveness and acceptability of accelerated repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant major depressive disorder: an open label trial. J Affect Disord, 2015, 173: 216-220.
27. Naro A, Russo M, Leo A, et al. A single session of repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex in patients with unresponsive wakefulness syndrome: preliminary results. Neurorehabil Neural Repair, 2015, 29(7): 603-613.
28. Krewer C, Hartl S, Muller F, et al. Effects of repetitive peripheral magnetic stimulation on upper-limb spasticity and impairment in patients with spastic hemiparesis: a randomized, double-blind, sham-controlled study. Arch Phys Med Rehabil, 2014, 95(6): 1039-1047.
29. Stultz DJ, Osburn S, Burns T, et al. Transcranial magnetic stimulation (TMS) safety with respect to seizures: a literature review. Neuropsychiatr Dis Treat, 2020, 16: 2989-3000.
30. Beaulieu LD, Schneider C. Effects of repetitive peripheral magnetic stimulation on normal or impaired motor control. A review. Neurophysiol Clin, 2013, 43(4): 251-260.
31. Chavez LM, Huang SS, MacDonald I, et al. Mechanisms of acupuncture therapy in ischemic stroke rehabilitation: a literature review of basic studies. Int J Mol Sci, 2017, 18(11): 2270.

West China Medical Journal

Effect of transcranial combined with peripheral repetitive magnetic stimulation on motor function after stroke

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