ABSTRACT
Abstract Background Phantom limb pain (PLP) occurs after amputations and can persist in a chronic and debilitating way. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation method capable of influencing brain function and modulating cortical excitability. Its effectiveness in treating chronic pain is promising. Objective To evaluate the evidence on the efficacy and safety of using rTMS in the treatment of PLP, observing the stimulation parameters used, side effects, and benefits of the therapy. Methods This is a systematic review of scientific articles published in national and international literature using electronic platforms. Results Two hundred and fifty two articles were identified. Two hundred and forty six publications were removed because they were duplicated or met the exclusion criteria. After selection, six studies were reviewed, those being two randomized clinical trials and four case reports. All evaluated studies indicated some degree of benefit of rTMS to relieve painful symptoms, even temporarily. Pain perception was lower at the end of treatment when compared to the period prior to the sessions and remained during patient follow-up. There was no standardization of the stimulation parameters used. There were no reports of serious adverse events. The effects of long-term therapy have not been evaluated. Conclusion There are some benefits, even if temporary, in the use of rTMS to relieve painful symptoms in PLP. High-frequency stimulation at M1 demonstrated a significant analgesic effect. Given the potential that has been demonstrated, but limited by the paucity of high-quality studies, further controlled studies are needed to establish and standardize the clinical use of the method.
Resumo Antecedentes A dor do membro fantasma (DMF) ocorre após amputações e pode persistir de forma crônica e debilitante. A estimulação magnética transcraniana repetitiva (EMTr) é um método de neuromodulação não invasivo capaz de influenciar a função cerebral e modular a excitabilidade cortical. Sua eficácia no tratamento da dor crônica é promissora. Objetivo Avaliar as evidências sobre a eficácia e segurança do uso da EMTr no tratamento da DMF, observando os parâmetros de estimulação utilizados, efeitos colaterais e benefícios da terapia. Métodos Trata-se de uma revisão sistemática de artigos científicos publicados na literatura nacional e internacional utilizando plataformas eletrônicas. Resultados Foram identificados 252 artigos. Duzentas e quarenta e seis publicações foram removidas por estarem duplicadas ou atenderem aos critérios de exclusão. Após a seleção, foram revisados seis estudos, sendo dois ensaios clínicos randomizados e quatro relatos de caso. Todos os estudos avaliados indicaram algum grau de benefício da EMTr no alívio dos sintomas dolorosos, mesmo que temporariamente. A percepção da dor foi menor ao final do tratamento quando comparada ao período anterior às sessões e permaneceu durante o acompanhamento do paciente. Não houve padronização dos parâmetros de estimulação utilizados. Não houve relatos de eventos adversos graves. Os efeitos da terapia a longo prazo não foram avaliados. Conclusão Existem alguns benefícios, mesmo que temporários, no uso da EMTr para alívio dos sintomas dolorosos na DMF. A estimulação de alta frequência em M1 demonstrou um efeito analgésico significativo. Dado o potencial demonstrado, mas limitado pela escassez de estudos de alta qualidade, são necessários mais estudos controlados para estabelecer e padronizar o uso clínico do método.
ABSTRACT
ABSTRACT BACKGROUND AND OBJECTIVES: Chronic Pelvic Pain (CPP) is characterized by persistent pain in the pelvic region for more than six months, affecting both men and women and causing significant impairment in quality of life (QoL). Two of the main non-invasive approaches are Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS). These techniques aim to modulate neural activity and promote pain relief. In this context, this research conducted an integrative literature review to summarize the results of relevant studies, aiming to identify the key parameters used in TMS and tDCS for CPP treatment. The objective was to assess the effect and efficacy of non-invasive neuromodulation as a therapeutic intervention for CPP. CONTENTS: For this integrative review, electronic searches were conducted in Pubmed, Scielo, PEDro, Medline, Cochrane, and Scopus databases, examining studies in Portuguese, English, or Spanish. The keywords "pelvic pain," "transcranial direct current stimulation," and "transcranial magnetic stimulation" and their derivatives were searched in the three languages in studies from 2013 to 2023. Seven studies were included for analysis. Both techniques showed positive effects in managing CPP, improving pain levels and quality of life to a relevant extent. However, there is still no consensus on the parameters applied in TMS and tDCS techniques for CPP. CONCLUSION: Non-invasive neuromodulation improves pain levels and quality of life in patients with CPP. Further studies are needed to establish more reliable parameter relationships, and the limited number of studies restricts definitive conclusions on the subject.
RESUMO JUSTIFICATIVA E OBJETIVOS: A dor pélvica crônica (DPC) é caracterizada pela persistência da dor na região pélvica por mais de seis meses, afetando tanto homens quanto mulheres e causando prejuízos significativos na qualidade de vida (QV). Duas das principais abordagens não invasivas são Estimulação Magnética Transcraniana (EMT) e a Estimulação Transcraniana por Corrente Contínua (ETCC). Nesse contexto, esta pesquisa realizou uma revisão integrativa da literatura com o intuito de resumir os resultados de estudos relevantes, buscando identificar os principais parâmetros utilizados no tratamento da DPC. O objetivo foi fornecer uma visão abrangente sobre essas técnicas de neuromodulação e suas aplicações específicas no controle da dor pélvica crônica. CONTEÚDO: Para esta revisão integrativa, as buscas eletrônicas ocorreram nas bases de dados Pubmed, Scielo, PEDro, Medline, Cochrane e Scopus, verificando estudos em português, inglês ou espanhol. "Dor pélvica", "estimulação transcraniana por corrente contínua" e "estimulação magnética transcraniana" e suas derivações foram pesquisadas nos três idiomas em estudos entre 2013 e 2023. Sete estudos foram incluídos para análise. Ambas as técnicas apresentaram efeitos positivos no manejo da DPC, melhorando os níveis de dor e a QV em proporções relevantes. Entretanto, ainda não há um consenso sobre os parâmetros aplicados nas técnicas de EMT e ETCC para DPC. CONCLUSÃO: A neuromodulação não invasiva melhora os níveis de dor e a QV em pacientes com DPC. São necessários mais estudos para que relações mais confiáveis de parâmetros possam ser preestabelecidas e a ausência de um maior número de estudos limita conclusões acerca do assunto.
ABSTRACT
La estimulación magnética transcraneal (EMT) es una técnica no invasiva que consiste en la utilización de campos magnéticos para estimular a las neuronas de la corteza cerebral. Si bien la electricidad se ha pretendido emplear previamente en el campo de la medicina, la historia de la EMT se remonta al descubrimiento de la inducción electromagnética, por Faraday, en el siglo XIX. Sin embargo, no fue hasta la década de 1980 cuando Anthony Barker, en la Universidad de Sheffield, desarrolló el primer dispositivo de EMT. La EMT funciona mediante una bobina colocada en el cuero cabelludo, la cual produce un campo magnético que puede atravesar el cráneo y estimular las neuronas corticales. La intensidad y la frecuencia del campo magnético pueden ajustarse para dirigirse a zonas específicas del cerebro y producir efectos excitatorios e inhibitorios. Los principios de la EMT se basan en el concepto de neuroplasticidad, que se refiere a la capacidad del cerebro para cambiar y adaptarse en respuesta a nuevas experiencias y estímulos. Al estimular las neuronas del cerebro con la EMT, es posible inducir cambios en la actividad neuronal y la conectividad, lo que a su vez puede provocar cambios cognitivos y en el estado de ánimo.
Transcranial magnetic stimulation (TMS) is a noninvasive technique that uses magnetic fields to stimulate neurons in the cerebral cortex. While electricity has previously been intended to be used in the medical field, the history of TMS dates back to the discovery of electromagnetic induction by Faraday in the 19th century. However, it was not until the 1980s when Anthony Barker developed the first TMS device at the University of Sheffield. TMS works by means of a coil placed against the scalp, thereby producing a magnetic field. This magnetic field can pass through the skull and stimulate cortical neurons. The intensity and frequency of the magnetic field can be adjusted to target specific areas of the brain and produce excitatory and inhibitory effects. The principles of TMS are based on the concept of neuroplasticity, which refers to the brain's ability to change and adapt in response to new experiences and stimuli. By stimulating neurons in the brain with TMS, it is possible to cause changes in neuronal activity and connectivity, which in turn can lead to cognitive and mood changes.
ABSTRACT
Pilot trials have suggested that repetitive transcranial magnetic stimulation (rTMS) may reduce limb spasticity in multiple sclerosis (MS). We carried out the current meta-analysis to synthesize currently available evidence regarding such correlation. Up to November 2022, five international electronic databases (Cochrane CENTRAL, PubMed, Embase, Web of Science, and CINAHL) and four Chinese electronic databases (CBM, CNKI, WanFang Data, and VIP) were systematically searched to identify randomized trials comparing active rTMS and sham stimulation in patients with MS-related spasticity. Two reviewers independently selected studies and extracted data on study design, quality, clinical outcomes, and time points measured. The primary outcome was clinical spasticity relief after intervention. Secondary outcomes included spasticity at the follow-up visit 2 weeks later and post-treatment fatigue. Of 831 titles found, we included 8 studies (181 participants) in the quantitative analysis. Pooled analyses showed that rTMS therapy was associated with significant spasticity relief in the early post-intervention period [standardized mean differences (SMD): -0.67; 95%CI: -1.12 to -0.21], but there was insufficient evidence for rTMS in reducing spasticity at the follow-up visit 2 weeks later (SMD: -0.17; 95%CI: -0.52 to 0.17) and fatigue (SMD: -0.26; 95%CI: -0.84 to 0.31). This evidence supports the recommendations to treat MS-related spasticity with rTMS, but underlines the need for further large randomized trials.
ABSTRACT
Depression is one of the most common mental disorders, which can be accompanied by cognitive symptoms in addition to core symptoms.With the improvement of the awareness of the disease, people pay more attention to the cognitive symptoms of depression. The cognitive impairment of patients not only appears in the onset of the disease, but also persists during the remission of the disease, which has a negative impact on the patients’ social function. Some cognitive assessment tools such as cognitive tests, event-related potential(ERP) and eye movement tracking technology have been used to assess cognitive impairment in patients with depression, which show that there are multidimensional cognitive impairments. Some therapeutic methods such as exercise therapy, repetitive transcranial magnetic stimulation(rTMS) and drug therapy have shown the potential to improve the cognitive function of patients with depression. This article reviews related researches in recent years to explore the cognitive impairment and therapeutic methods of patients with depression.
ABSTRACT
Objective:To investigate the effects of repetitive transcranial magnetic stimulation combined with paroxetine hydrochloride on executive function in depressed adolescents with non-suicidal self-injury.Methods:The clinical data of 120 depressed adolescents with depressive disorders who were admitted to The Second Hospital of Jinhua from August 2021 to July 2022 were retrospectively analyzed. They were randomly assigned to undergo treatment either with paroxetine hydrochloride (control group, n = 60) or repetitive transcranial magnetic stimulation combined with paroxetine hydrochloride (observation group, n = 60). All patients were treated for 2 months. Hamilton Depression Rating Scale-24 (HAMD-24) score, Non-suicidal Self-injury Behavior and Function Scale for Adolescents (ANSSIQ) score, executive function, brain-derived neurotrophic factor, 5-hydroxytryptamine, and clinical efficacy were determined in each group. Results:After treatment, the Hamilton Depression Rating Scale-24 score in the observation group was significantly lower than that in the control group [(15.85 ± 1.08) points) vs. (18.72±1.21) points, t = 13.71, P < 0.001). After treatment, the number of self-injury attacks, number of self-injury impulsions, and the intensity of self-injury thought within 2 weeks in the observation group were significantly lower than those in the control group ( t = 3.42, 3.03, 1.92, all P < 0.05). The scores of the Trail Making Test, Stroop Word test, Stroop Color test, and Stroop Color-Word Interference Test were significantly higher in the observation group than those in the control group ( t = 2.66, 3.33, 3.97, 4.64, all P < 0.01). Brain-derived neurotrophic factor and 5-hydroxytryptamine levels in the observation group were (11.45 ± 1.79) μg/L and (136.68 ± 11.90) μg/L, respectively, which were significantly higher than (9.06±2.21) μg/L and (124.82 ± 10.34) μg/L in the control group ( t = 6.51, 5.83, both P < 0.001). The total response rate in the observation group was significantly higher than that in the control group (91.7% vs. 78.3%, Z = 2.73, P = 0.006). Conclusion:Repetitive transcranial magnetic stimulation combined with paroxetine hydrochloride is highly effective on depressive disorders in adolescents with non-suicidal self-injury. The combined therapy can reduce symptoms, improve executive function and cognitive function, and optimize serological indicators, and thereby deserves the clinical promotion.
ABSTRACT
Objective:To investigate the curative effects of Beck's cognitive therapy (BCT) combined with transcranial magnetic stimulation (TMS) on post-stroke sleep disorders in patients.Methods:A total of 120 patients with post-stroke sleep disorders who were diagnosed and treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January and December 2020 were included in this study. They were randomly assigned to undergo TMS (TMS group), BCT (BCT group), or TMS plus BCT (combined group) ( n = 40/group). Before and after treatment, sleep quality and mental state scores were evaluated in each group. Results:After treatment, the Pittsburgh Sleep Quality Index (PSQI) score in the combined group [(5.68 ± 0.33) points] was significantly lower than that in the TMS group [(9.11 ± 0.83) points] and BCT group [(11.37 ± 1.06) points, F = 512.63, P < 0.001]. Sleep efficiency in the combined group [(56.73 ± 2.62)%] was significantly higher than that in the TMS group [(39.55 ± 3.02)%] and BCT group [(35.23 ± 1.41)%, F = 863.59, P < 0.001]. The Self-Rating Anxiety Scale (SAS) scores and Self-Rating Depression Scale (SDS) scores were significantly lower in the combined group compared with the TMS and BCT groups ( F = 412.52, 310.60, both P < 0.001). Conclusion:BCT combined with TMS can effectively improve sleep quality and reduce negative emotions in patients with post-stroke sleep disorders.
ABSTRACT
Objective:To investigate the effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with music biofeedback on insomnia.Methods:Sixty patients with insomnia who received treatment in Outpatient Department of Seventh People's Hospital of Dongyang from January to August 2021 were included in this study. They were randomly divided into an observation group ( n = 30) and a control group ( n = 30) using the random number table. The control group was given music biofeedback therapy and conventional drug treatment, and the observation group was treated with rTMS based on music biofeedback therapy. The changes in polysomnography sleep structure and Pittsburgh Sleep Quality Index score after 1 month of treatment relative to before treatment were determined in each group. Results:After 1 month of treatment, the total sleep time, sleep efficiency, rapid eye movement (REM) sleep, non-REM sleep phase II (N2%) and non-REM sleep phase III (N3%) in the observation group were (419.87 ± 42.63) minutes, (83.69 ± 13.39)%, (25.27 ± 3.26)%, (53.75 ± 11.36)% and (16.27 ± 2.25)%, respectively, and they were (388.74 ± 40.39) minutes, (76.38 ± 13.17)%, (23.16 ± 2.68)%, (51.62 ± 12.27)%, and (14.36 ± 2.21)%, respectively. There were significant differences in these indices between the two groups ( t = -2.90, -2.13, -2.22, -2.26, -3.31, P = 0.005, 0.037, 0.030, 0.027, 0.002). The sleep latency, actual wake time, numbet of awakenings, non-REM sleep phase I (N1%), and total score of Pittsburgh Sleep Quality Index in the observation group were (24.16 ± 7.82) minutes, (23.18 ± 6.95) minutes, (1.76 ± 0.28) times, (9.74 ± 2.12)%, (9.17 ± 1.56) minutes, respectively. They were (28.35 ± 7.74) minutes, (28.36 ± 7.21) minutes, (2.25 ± 0.79) times, (11.12 ± 1.17)%, and (10.26 ± 1.42) minutes, respectively in the control group. There were significant differences in these indices between the two groups ( t = 2.09, 2.83, 3.20, 3.12, 2.83, P = 0.041, 0.006, 0.002, 0.003, 0.038). Conclusion:rTMS combined with music biofeedback for the treatment of insomnia can effectively improve sleep quality in patients with insomnia.
ABSTRACT
Abstract@#Repetitive Transcranial Magnetic Stimulation is a non-invasive brain stimulation process popularly used to treat psychiatric disorders. Multiple evidence shows effectiveness of rTMS in treating addiction, particularly in tobacco or cigarette users. This study consisted of review of current published literatures on repetitive transcranial magnetic stimulation following predefined eligibility criteria. The studies included evaluated at least one of the epidemiological parameters: (i) the meaning of repetitive transcranial magnetic stimulation (ii) Effectiveness of the Repetitive Transcranial Magnetic Simulation Over Behavioral therapy (iii) rTMS-associated adverse events among tobacco users@*Methodology@#We included published studies discussing rTMS in smoking cessation which examined if these interventions were effective and identified whether it has a severe negative effect on the patients. A total of 104 related studies were identified through database searches (Pubmed, Elsevier, Cochrane). Of which, 53 duplicate studies were removed. Five studies were then excluded with more than 10 years in publication. A total of 28 papers were then included in the study.@*Conclusion@#We conclude that rTMS is more effective in treating addiction in terms of smoking compared to behavioral therapy and rTMS affects triggered desired circuit which may be crucial among tobacco users. Individual neuronal excitability in the specific region’s subsequent induction may impact the therapeutic outcomes. With this, the high-frequency rTMS sequentially applied to the left superior medial frontal cortex and dorsolateral prefrontal cortex may be an effective tool for improving the cessation rate.
Subject(s)
Transcranial Magnetic Stimulation , Smoking CessationABSTRACT
ObjectiveTo investigate the effect of combination with repetitive transcranial magnetic stimulation (rTMS) and median nerve electrical stimulation (MNS) on patients with prolonged disorders of consciousness (pDOC) in different age. MethodsFrom January, 2021 to May, 2023, 93 patients with pDOC in the First Affiliated Hospital of Nanchang University were divided into young group (≤ 45 years old), middle-aged group (46 to 60 years old) and elderly group (> 60 years old). All the groups were treated with rTMS and MNS for four weeks. The Coma Recovery Scale-Revised (CRS-R), Glasgow Coma Scale (GCS), and Full Outline of Unresponsiveness Scale (FOUR) were used to evaluate the efficiency of awakening after treatment and the awakening ratios were compared among three groups weekly. Four weeks after treatment, regional cerebral blood flow (rCBF) was measured with CT perfusion imaging. The score of Glasgow Outcome Scale Extended (GOS-E) was compared six months after treatment. ResultsFrom three weeks after treatment, the scores of CRS-R, GCS and FOUR increased in all groups (P < 0.05). After weekly treatment, there was no significant difference in the composition ratio of consciousness level and the awakening ratio among three groups (χ2 < 11.057, P > 0.05). After four weeks of treatment, rCBF improved in three groups (|t| > 2.495, P < 0.05), however, there was no difference among three groups (F < 1.887, P > 0.05). There was no difference in the score of GOS-E at six months after treatment (F = 3.083, P = 0.055). ConclusionrTMS combined with MNS is effective on pDOC patients in different ages, and elderly patients could also benefit from it.
ABSTRACT
ObjectiveTo observe the effect of bilateral sequential repetitive transcranial magnetic stimulation on the motor function of upper limbs in stroke patients. MethodsFrom December, 2020 to December, 2022, 62 stroke inpatients in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were included. They were randomly divided into control group (n = 31) and observation group (n = 31). Both groups accepted conventional medicine and rehabilitation, as well as electroacupuncture antagonistic muscle therapy. Before electroacupuncture, the observation group acceped low-frequency repetitive transcranial magnetic stimulation at primary motor cortex (M1) on the healthy side, followed by intermittent theta burst stimulation at M1 on the affected side, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), modified Barthel Index (MBI) and modified Ashworth Scale (MAS), and motor evoked potential (MEP) latency was compared before and after treatment. ResultsOne patient dropped down in the observation group, and no adverse event happened. After treatment, the scores of FMA-UE and MBI significantly increased (|t| > 9.953, P < 0.001), and the score of MAS and the latency of MEP significantly decreased (|t| > 5.043, P < 0.001) in both groups; while all of them were better in the observation group than in the control group (|t| > 2.237, P < 0.05). ConclusionBilateral sequential repetitive transcranial magnetic stimulation can effectively promote the recovery of upper limb motor function in stroke patients.
ABSTRACT
ObjectiveTo explore the therapeutic effect and mechanism of intermittent theta burst transcranial magnetic stimulation (iTBS) on non-fluent aphasia after stroke. MethodsFrom August, 2021 to August, 2022, 50 patients with non-fluent aphasia after stroke in the First People's Hospital of Lianyungang were randomly divided into sham stimulation group (n = 25) and iTBS group (n = 25). Both groups accepted speach training. iTBS group accepted iTBS, and the sham stimulation group received sham iTBS, for four weeks. The serum brain-derived neurotrophic factor (BDNF) was measured, and they were assessed by China Rehabilitation Research Center Standard Aphasia Examination (CRRCAE) and Boston Diagnostic Aphasia Examination before and after treatment. ResultsTwo cases in the sham stimulation group and three cases in iTBS group dropped down. The BDNF level, and listen and understand, repeat, name, read aloud, and total score of CRRCAE improved in two groups after treatment (|t| > 5.012, P < 0.001); and they were better in iTBS group than in the sham stimulation group (|t| > 3.968, P < 0.001). The total effective rate was more in iTBS group than in the sham stimulation group (χ2 = 8.835, P < 0.05). ConclusioniTBS can improve speech function in patients with non-fluent aphasia after stroke, which may associate with the promotion of BDNF.
ABSTRACT
ObjectiveTo investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia. MethodsSixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device. ResultsAfter treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R2 > 0.804, P < 0.001). ConclusionThe combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.
ABSTRACT
Objective:To observe any effects of contralateral repeated transcranial magnetic stimulation (rTMS) of the swallowing motor cortex on the swallowing and brainstem auditory evoked potentials (BAEPs) of stroke survivors with dysphagia.Methods:A total of 83 stroke survivors with dysphagia were randomly divided into an ipsilesional stimulation group ( n=22), a contralesional stimulation group ( n=21), a bilateral stimulation group ( n=20), and a control group ( n=20). In addition to their conventional dysphagia training, those in the three stimulation groups received 3Hz rTMS while the control group was given fake stimulation. The treatment was administered daily for 20 minutes, 6 days a week, for 5 consecutive weeks. Before and after the treatment, swallowing function was assessed videofluoroscopically and using the Dysphagia Outcome and Severity Scale (DOSS). The oral and pharyngeal stages of swallowing were evaluated using the videofluoroscopic dysphagia scale (VDS). Brain stem conduction was assessed using BAEPs. Results:After treatment the average DOSS scores of all 4 groups were significantly better than before the treatment. The average DOSS scores of the contralesional and bilateral sti-mulation groups were then significantly better than those of the other two groups. The sub-item and total VDS scores of all 4 groups had decreased significantly, but the average score of the bilateral stimulation group was significantly lower than the control group′s average. Ipsilesional stimulation significantly improved the VDS sub-item scores for the triggering of pharyngeal swallowing, laryngeal elevation, and pharyngeal transit time compared with the control group. In the contralesional stimulation group the average total score and the VDS sub-item scores for apraxia, premature bolus loss, oral transit times, the triggering of pharyngeal swallowing, vallecular residue, laryngeal elevation, coating on the pharyngeal wall, and pharyngeal transit time were significantly lower than those of the control group, on average. After the treatment the latencies of BAEP waves I, III and V and the I-III, III-V and I-V interpeak intervals had decreased significantly in all four groups, but the average latencies and intervals of the bilateral and contralesional groups were significantly shorter than those of the control group. The latencies and intervals of the bilateral stimulation group were then significantly shorter than those in the ipsilesional stimulation group on average. The average latency of wave V in the bilateral stimulation group (6.53±0.73ms) was significantly shorter than that in the contralesional stimulation group after the treatment.Conclusion:Bilateral rTMS over the swallowing motor cortex combined with conventional dysphagia training can significantly improve the swallowing of dysphagic stroke survivors.
ABSTRACT
Objective:To observe the clinical efficacy of combining repeated transcranial magnetic stimulation (rTMS) with radiofrequency ablation (RF) of dorsal root ganglia in treating herpes zoster infection and neuralgia.Methods:Eighty-four individuals with a herpes zoster infection who had suffered from neuralgia for no more than 7 days were divided randomly into a control group, an rTMS group, an RF group, and an observation group, each of 21. All were treated with gabapentin, valciclovir and mecobalamin. The rTMS group received rTMS treatment, 5 days per week, for 2 consecutive weeks. The RF group received RF treatment of the dorsal root ganglia on the 15th day after enrollment, while the observation group received only the medication. Before the experiment as well as after 3, 7, 16, 30 and 60 days, all of the subjects self-assessed their discomfort using a pain visual analog scale (VAS). The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Quality of Life Assessment Scale (QOL-SF36), and Pittsburgh Sleep Quality Index (PSQI) were also administered.Results:The average VAS, HAMA, HAMD, QOL-SF36, and PSQI scores of the observation group improved continuously and significantly during and after the treatment. Beyond 16 days all of those results were significantly better than the control group′s averages, and the observation group′s average VAS, HAMA and HAMD results were also significantly better than those of the rTMS group. The observation group′s average VAS, HAMA, HAMD and PSQI scores had improved significantly more than the RF group′s averages beyond 30 days.Conclusion:Combining rTMS and dorsal root ganglion RF can effectively alleviate the early pain symptoms of herpes zoster infection and neuralgia, relieve anxiety and depression, and significantly improve sleep and life quality. Such therapy is worthy of clinical promotion and application.
ABSTRACT
Objective:To observe any effect of combining low-frequency transcranial magnetic stimulation (rTMS) with interactive virtual scenario training on the recovery of upper limb motor function after a stroke.Methods:Ninety stroke survivors were randomly divided into a pseudo-rTMS group, an rTMS group and a combination group, each of 30. In addition to basic medication, conventional rehabilitation and nursing care, the pseudo-rTMS, rTMS and combination groups received either sham rTMS treatment, 1Hz rTMS or virtual situational interaction along with 1Hz rTMS 5 days a week for 4 weeks. Before and after the 4 weeks their motor evoked potentials, cortical latency and central motor conduction time were measured, and surface electromyography was applied to the affected biceps brachii and triceps brachii. Meanwhile, the National Institutes of Health Stroke Scale, the Fugl-Meyer upper extremity assessment and the modified Barthel index were employed to assess the degree of neurological deficit, upper extremity motor function and ability in the activities of daily living (ADL).Results:After the 4-week intervention, a significant improvement was observed in all of the outcome measurements with all three groups. At that time the average scores of the rTMS group were significantly better than the pseudo-rTMS group′s averages but the average scores of the combination group were significantly better than those of either of the other two groups.Conclusion:Repeated application of low-frequency transcranial magnetic stimulation combined with virtual scenario interactive training can effectively improve the upper limb motor function and ADL performance of stroke survivors, and relieve the symptoms of neurological deficit. The combined therapy is worthy of application in clinical practice.
ABSTRACT
Objective:To explore any effect of repeated application of low-frequency transcranial magnetic stimulation (rTMS) on depression and the cognition of depressed elderly persons.Methods:Eighty-six elderly persons with depression were randomly divided into an rTMS group and a control group, each of 43. In addition to anti-depressant treatment, the rTMS group was given 20 minutes of 1Hz rTMS daily applied over the right dorsolateral prefrontal cortex, five times a week for 4 weeks. The control group was given sham treatment on the same schedule. Before the experiment and after 1, 2, 3, 4, 6 and 8 weeks of the treatment, depression in both groups was evaluated using the Hamilton Depression Scale (HAMD-24). At the 4- and 8-week evaluations the Wisconsin Card Sorting Test (WCST) and the Trail Making Test Part A (TMT-A) were also administered.Results:Before the treatment there were no significant differences in the 2 groups′ average HAMD or WCST scores. At each subsequent evaluation both groups′ average HAMD score had decreased significantly. After 3 weeks the average HAMD score of the rTMS group consistently remained significantly lower than the control group′s average. At the 4- and 8-week evaluations both groups′ WCST and TMT-A scores had improved significantly compared with before the treatment, with significantly greater improvement in the rTMS group′s average WCST result, though not in their TPT-A result. There was no signi-ficant difference in the incidence of adverse reactions between the 2 groups.Conclusion:As a supplement to antidepressant treatment, right-side low-frequency rTMS can relieve depressive symptoms and improve the cognitive functioning of depressed elderly persons. It is well tolerated with few adverse reactions.
ABSTRACT
Objective:To explore any effect of supplementing psychological intervention with repeated transcranial magnetic stimulation (rTMS) in the rehabilitation of depressed persons with Parkinson′s disease (dPD).Methods:A total of 120 dPD patients were randomly divided into a psychological intervention group, an rTMS treatment group and an observation group, each of 40. In addition to conventional anti-Parkinson′s treatment and anti-depressant treatment, the psychological intervention group received such treatment and the rTMS group received 10Hz rTMS applied over the left dorsolateral prefrontal cortex for 8 weeks. The observation group received both interventions. Before and after the treatment, depression, neurological functioning and life quality were evaluated in all of the subjects using the 24-item Hamilton Depression Scale, the Movement Disorder Society′s unified Parkinson′s disease rating scale and the SF-36 questionnaire.Results:After the intervention, significant improvement was observed in all of the quantitative evaluations as well as in the remission rate (40%) and the reaction rate (90%). On average, the observation group′s results were significantly better than those of the other two groups.Conclusion:Psychological intervention and rTMS a have synergistic effect in treating dPD patients and their combination is worthy of clinical promotion and application, as it can relieve their depression and improve their neurological functioning and life quality.
ABSTRACT
Objective:To explore any effect of supplementing low-frequency repeated transcranial magnetic stimulation (rTMS) with intermittent resistance training on muscle tone and the recovery of motor function among persons with Parkinson′s disease (PD).Methods:A total of 104 PD patients were randomly divided into an observation group and a control group, each of 52. Both groups were treated with conventional drugs and low-frequency rTMS, while the observation group was additionally provided with intermittent resistance training for 8 weeks. Before and after the intervention, the motor functioning of both groups was evaluated using unified Parkinson′s disease rating scale-III (UPDRS-III) and the Berg Balance Scale (BBS). Limb muscle tension was quantified using the modified Ashworth scale (MAS). The subjects′ psychological states were quantified using the exercise self-efficacy scale (ESE), and the modified Barthel index (MBI) was applied to evaluate their ability in the activities of daily living. A 3D motion processing system collected and analyzed data describing each subject′s gait kinematics.Results:After the intervention, significantly greater average improvement was observed in all of the outcome measures among the observation group compared with the control group.Conclusion:Combining intermittent resistance training with low-frequency rTMS can significantly reduce muscle tone and improve the motor functioning of PD patients. The combination is more effective than low-frequency rTMS alone.
ABSTRACT
Objective:To observe any effect of supplementing conventional rehabilitation training with repeated transcranial magnetic stimulation (rTMS) in the treatment of lumbar disc herniation (LDH).Methods:Seventy-two LDH patients were randomly divided into an rTMS group ( n=24), a training group ( n=24), and a combined group ( n=24). The rTMS group received 2Hz rTMS at an intensity of 80% resting motor threshold with a total of 1000 pulses, the training group was given Mackenzie therapy and lumbar core muscle stability training, while the combined group was provided with both. Each group was treated once a day, 6 times a week for 8 weeks. The participants rated their pain using a visual analog scale (VAS), and the Oswestry dysfunction index (ODI) was also used to evaluate the degree of pain and dysfunction in all three groups before and right after the treatment, as well as 8 weeks later. After the treatment, its therapeutic effect was evaluated using the improved Macnab standard. Each patient was followed up for 12 months and any recurrence was recorded. Results:Before treatment there was no significant difference in average VAS ratings or ODI scores among the three groups. Afterward, pain and dysfunction were relieved significantly in all three groups. Compared with the rTMS group, the average VAS rating in the training group was significantly higher and the average ODI score was significantly lower after the treatment and during the follow-up. Moreover, the average VAS rating and ODI score of the combined group were significantly lower than those in the other two groups after the treatment and during follow-up. The total effectiveness rate in the rTMS group was assessed as 62.5% compared with 95.8% in the training group and 100% in the combined group-a significant difference for the rTMS group. Follow-up showed that the recurrence rates of the rTMS group, training group and combined group were 37.5%, 25% and 8.3%, respectively-a significant difference in the case of the combined group.Conclusion:rTMS combined with rehabilitation training can relieve pain, improve lumbar function and reduce the recurrence of LDH.