Analysis on application effect of hrTMS combined with MSS in patients with prolonged disorders of consciousness after severe traumatic brain injury / 重庆医学

Objective To investigate the effect of high-frequency repetitive transcranial magnetic stimu-lation(hrTMS)combined with multi-sensory stimulation(MSS)in the patients with prolonged disorders of consciousness(PDOC)after severe traumatic brain injury(STBI).Methods Ninety-two patients with PDOC caused by STBI in this hospital from March 2020 to November 2022 were selected as the study subjects and e-venly divided into the observation group(conventional treatment+MSS+hrTMS)and control group(con-ventional treatment+MSS)by adopting the random number table method,46 cases in each group.The elec-troencephalogram examination results,Glasgow Coma Scale(GCS),Disability Rating Scale(DRS)and Coma Recovery Scale-revised(CRS-R)scores before intervention and in 2 months after and intervention and the wake-promoting effective rates after intervention were compared between two groups.Results Compared with before intervention,the electroencephalogram(EEG)grade after intervention in the two groups was sig-nificantly improved,moreover the observation group was superior to the control group(P＜0.05).Compared with before intervention,the GCS and CRS-R scores after intervention in the two groups were increased,the DRS score was decreased,moreover the GCS and CRS-R scores in the observation group were higher than those in the control group,while the DRS score was lower than that in the control group(P＜0.05).After in-tervention,the wake-promoting effective rate in the observation group was higher than that in the control group(76.1％vs.54.3％),and the difference was statistically significant(P＜0.05).Conclusion The hrT-MS combined with MSS has good effect for improving PDOC after STBI.

Transcranial magnetic stimulation can alleviate sleep disorders in children with cerebral palsy / 中华物理医学与康复杂志

Objective:To observe any effect of repetitive transcranial magnetic stimulation (rTMS) on sleep disorders among children with cerebral palsy (CP).Methods:A total of 102 children with CP and disordered sleep were randomly divided into an experimental group and a control group, each of 51. All were given routine rehabilitation and sleep health education, but the experimental group additionally received rTMS for two weeks. The polysomnography (PSG) results of the two groups were recorded and analyzed.Results:The PSG parameters had improved greatly in both groups after the treatment. The percentage of N2 sleep (depth of sleep during light sleep) in the severe cerebral palsy group and of N3 sleep (depth of sleep during deep sleep) in the moderate cerebral palsy group had increased significantly more than in the mild cerebral palsy group, on average. After the intervention the percentages of N2 and N3 in those with mixed cerebral palsy and of N3 in those with involuntary motor cerebral palsy had increased significantly more than in those with spastic cerebral palsy, on average.Conclusion:rTMS treatment can improve the sleep disorders of children with cerebral palsy, especially N2 sleep among children with moderate to severe cerebral palsy, N3 sleep in cases of mixed or dyskinetic CP.

Efficacy and safety profile of repetitive transcranial magnetic stimulation versus modified electroconvulsive therapy in combination with antidepressants in patients with major depressive disorder / 四川精神卫生

BackgroundMajor depressive disorder is one of the most disabling mental diseases. Currently， medication in combination with physiotherapy and psychotherapy remains the most commonly used treatment modality for the disease， whereas only a few randomized controlled studies have been conducted on physiotherapy， and even fewer studies have focused on medication combined with physiotherapy. ObjectiveTo explore the efficacy and safety profile of repetitive transcranial magnetic stimulation （rTMS） versus modified electroconvulsive therapy （MECT） in combination with antidepressants in the treatment of major depressive disorder， so as to provide an optimized treatment plan for patients with major depressive disorder. MethodsPatients with major depressive disorder （n=335） hospitalized in Shandong Daizhuang Hospital from January 1， 2019 to April 30， 2023 were included， all of whom met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10）. Depending on their disease condition， patients were subjected to either MECT in combination with drugs （n=141） or rTMS in combination with drugs （n=194） after admission. Depressive symptoms were assessed using Hamilton Depression Scale-24 item （HAMD-24） at the baseline and the end of the 1st， 2nd， 3rd and 4th week of treatment， and the adverse reactions were documented in patient's medical records. ResultsAnalysis of variance on HAMD-24 revealed a significant effect of time （F=3.081， P=0.042）， but no effect of group （F=1.023， P=0.313）， and the interaction effect between the time and the groups was not statistically significant （F=1.642， P=0.191）. No statistical difference was reported between two groups in response rate and full remission rate （P>0.05）. Throughout the course of treatment， 58 cases （41.13%） of recent memory impairment and 74 cases （52.48%） of headache or neck muscle pain occurred in MECT combined with drugs group， and 27 cases （13.92%） in rTMS combined with drugs group experienced headache or head skin discomfort. ConclusionAntidepressants in combination with rTMS or MECT show equivalent efficacy in the treatment of major depressive disorder， while rTMS combined with antidepressants demonstrates a superior safety profile compared to MECT.

Recent advance in clinical application of transcranial magnetic stimulation in post-traumatic depression / 中华神经医学杂志

Post traumatic depression (PTD) is a serious complication after traumatic brain injury, with high incidence rate; PTD seriously affects the rehabilitation, outcome and quality of life of patients. Due to unclear pathogenesis of PTD, effective treatments have not yet been found in clinical practice. Repetitive transcranial magnetic stimulation (rTMS), as a new non-invasive neuroregulatory technique, has been used in major depression disorder (MDD). Few clinical evidence on PTD treated by rTMS is noted and optimal rTMS treatment regimen has not yet been defined.This article reviews the clinical studies of rTMS in PTD in recent years, with a view to provide references for clinical application.

Efficacy and influencing factors of repetitive transcranial magnetic stimulation in the treatment of chronic insomnia / 四川精神卫生

BackgroundChronic insomnia is characterized by a prolonged and recurrent course. The efficacy of repeated transcranial magnetic stimulation （rTMS） as a physical therapy method to improve sleep quality remains inadequately supported by evidence， particularly regarding its relationship with personality traits. ObjectiveTo explore the efficacy and influencing factors of rTMS in the treatment of chronic insomnia， and to provide insights into its therapeutic potential. MethodA total of 46 patients who met the diagnostic criteria for chronic insomnia according to the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5）， and were treated at the Third Hospital of Mianyang from September 2022 to September 2023 were selected. Prior to treatment， participants underwent assessments using the Eysenck Personality Questionnaire （EPQ）， Hamilton Depression Scale-17 item （HAMD-17） and Hamilton Anxiety Scale （HAMA）. The Pittsburgh Sleep Quality Index （PSQI） was used to assess sleep quality before treatment， at the end of the second week of treatment and one week post-treatment. ResultsAt the end of the second week of treatment， patients exhibited significantly improved total PSQI score and subscale scores related to subjective sleep quality， sleep latency， sleep duration， sleep efficiency， sleep disturbance and daytime dysfunction （t=4.755~13.361， P<0.01）， with 24 cases （54.35%） showing effective treatment outcomes. Multiple linear regression analysis showed that introverted and extroverted personality traits contributed significantly to the regression equation （B=0.317， P<0.01）， explaining 29.90% of the total variation （R2=0.299）. ConclusionrTMS treatment may effectively improve the sleep quality of patients with chronic insomnia， with its therapeutic effect appearing to associated with introverted and extroverted personality traits. ［Funded by National Natural Science Project of China （number， 82372080）］

Effect of high-frequency repetitive transcranial magnetic stimulation in M1 region combined with dorsolateral prefrontal cortex on electroencephalogram θ frequency band amplitude of patients with neuropathic pain after spinal cord injury / 中国康复理论与实践

ObjectiveTo explore the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) in M1 region combined with dorsolateral prefrontal cortex (DLPFC) on electroencephalogram (EEG) θ frequency band amplitude of patients with neuropathic pain (NP) after spinal cord injury. MethodsFrom June, 2022 to June, 2023, 50 NP patients after SCI in Qingdao University Affiliated Hospital were included and divided into M1 region stimulation group (n = 25) and M1 region combined with DLPFC stimulation group (the combined stimulation group, n = 25). M1 region stimulation group received 10 Hz rTMS in the left M1 region, while the combined stimulation group received same stimulation in left M1 region combined with DLPFC, for three weeks. Before and after intervention, the pain was assessed with Short Form of McGill Pain Questionnaire (SF-MPQ), the depression and anxiety status were evaluated using Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), and the EEG θ frequency band amplitude was recorded to detect the changes of brain electrophysiological activity. ResultsFour cases in M1 region stimulation group, and two cases in the combined stimulation group were dropped. After intervention, the total score of SF-MPQ and the scores of the subscales, the scores of HMMD and HAMA decreased in both groups (|t| > 2.523, P < 0.05). The EEG θ frequency band amplitude significantly reduced in the prefrontal and frontal regions in M1 region stimulation group (|t| > 5.243, P < 0.001), and it also significantly reduced in the prefrontal, frontal regions, central and parietal regions in the combined stimulation group (|t| > 4.630, P < 0.001). All the scores were lower (|t| > 2.270, Z = -1.973, P < 0.05), and the EEG θ frequency band amplitude in the prefrontal, frontal regions, central and parietal regions were lower (P < 0.05) in the combined stimulation group than in M1 region stimulation group. ConclusionHigh frequency rTMS is an effective analgesic method on NP after SCI, which can improve their depression and anxiety symptoms and reduce the EEG θ frequency band amplitude. Compared with M1 region rTMS stimulation, the combination of M1 region and DLPFC rTMS is more effective.

Effects of low frequency repetitive transcranial magnetic stimulation combined with rehabilitation robot on the recovery of hand dysfunction in stroke patients / 中国康复医学杂志

Objective:To observe the therapeutic effect of low-frequency repetitive transcranial magnetic stimulation com-bined with rehabilitation robot on hand dysfunction in stroke patients. Method:Totally 36 patients with stroke hand dysfunction treated in the Rehabilitation Department of Jinshan Hospital were randomly divided into the experimental group(n=18)and the control group(n=18).Both groups of patients received routine treatment.Both groups were treated with 1Hz repetitive transcranial magnet-ic stimulation on the unaffected side,and the experimental group was added by a hand function rehabilitation robot.Both groups were treated 5 times a week for 4 weeks.The assessment were evaluated before treatment,2 weeks and 4 weeks after treatment,including the latency of cortical motor evoked potential(MEP),central motor conduction time(CMCT),Fugl-Meyer assessment(FMA)score and motor intensity index(MI)score. Result:After 4 weeks of treatment,MEP,CMCT,FMA and MI of the two groups were significantly im-proved compared with those before treatment(P＜0.001).After 4 weeks of treatment,MEP,CMCT,FMA and MI in the experimental group were significantly improved compared with those in the control group(P＜0.05). Conclusion:The contralateral low-frequency repetitive transcranial magnetic stimulation combined with rehabilita-tion robot can significantly improve hand dysfunction in stroke patients.

Effects of repetitive transcranial magnetic stimulation on clinical symptoms and plasma MiR-125b,phos-phorylated Tau181 protein in patients with Alzheimer's disease / 中国康复医学杂志

Objective:To observe the effects of repetitive transcranial magnetic stimulation(rTMS)on cognitive function,neuropsychiatric behavioral symptoms,expression of plasma microRNA-125b(miR-125b)and phosphorylated Tau181 protein(P-Tau181)of patients with Alzheimer's disease(AD). Method:Thirty-four patients with mild to moderate AD were screened and randomly divided into control group(n=16)and experimental group(n=18).The control group received cognitive training and repetitive tran-scranial magnetic pseudo-stimulation,and the experimental group received cognitive training and repetitive tran-scranial magnetic real stimulation.The magnetic stimulation intensity was 100％resting movement threshold(RMT),frequency was 10Hz.It's administered once a day,5 days a week for 4 weeks.The stimulation site were the left dorsolateral prefrontal lobe and left temporal lobe.The Addenbrooke Ⅲ cognitive examination(ACE-Ⅲ),mini-mental state scale(MMSE)and neuropsychiatric inventory(NPI)were evaluated before and af-ter treatment.The microRNA-125b expression was detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR)and the concentration of P-Tau181 was determined by enzyme-linked immunosorbent assay(ELISA). Result:After treatment,the scores of ACE-Ⅲ,MMSE and NPI,miR-125b and P-Tau181 in the experimental group were significantly improved compared with those before treatment(P＜0.05).There was no improvement of all indexes in the control group(P＞0.05). Conclusion:rTMS improve the cognitive function and neuropsychiatric symptoms of patients with mild to mod-erate AD,which may be related to the promotion of plasma miR-125b expression and inhibition of P-Taul81 protein production by rTMS.It is worthy for clinical application.

Effects of low-frequency and high-frequency repetitive transcranial magnetic stimulation combined with levodopa and benserazide hydrochloride on mild cognitive impairment in patients with Parkinson disease / 中华行为医学与脑科学杂志

Objective:To investigate the effects of low-frequency and high frequency repetitive transcranial magnetic stimulation (rTMS) combined with levodopa and benserazide hydrochloride on mild cognitive impairment in patients with Parkinson disease (PD).Methods:Totally 90 PD patients with mild cognitive impairment who visited from January 2020 to June 2022 were included , and they were divided into a simple drug group ( n=30), drug+ low-frequency group ( n=30), and drug+ high-frequency group ( n=30) according to the order of admission.The patients in the simple drug group were treated with oral levodopa and benserazide hydrochloride, while the patients in drug+ low-frequency and drug+ high-frequency groups were treated with low-frequency or high-frequency rTMS on the basis of oral levodopa and benserazide hydrochloride.Montreal cognitive assessment(MoCA), digital span (DS), Chinese auditory learning test (CALT), the judgment of line orientation test (JLOT) and verbal fluency test (VFT) were used to evaluate the cognitive function of patients before and after 4 weeks of treatment.SPSS 26.0 was used for statistical analysis.The paired t-test was used for intra-group comparison before and after treatment, while one-way ANOVA was used for inter-group comparison. Results:There were no significant differences in MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT, and VFT scores among patients in the simple drug group before and after 4 weeks of treatment( t=-1.157, -0.648, -0.215, -0.290, -0.154, -0.782, -0.960, all P>0.05). After 4 weeks of treatment, MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT and VFT scores in drug+ low-frequency group and drug+ high-frequency group were higher than before treatment (drug+ low frequency group: t=-16.357, -11.379, -7.999, -11.805, -16.624, -15.996, -17.241, all P<0.05; drug+ high-frequency group: t=-25.198, -13.971, -13.904, -25.831, -26.382, -20.108, -15.643, all P<0.05). There were no statistically significant differences in the scores of MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT and VFT among the three groups before treatment (all P>0.05). After treatment, there were statistically significant differences in the scores of MoCA, DS anterograde, DS backward, CALT immediate recall, CALT delayed recall, JLOT and VFT among the three groups (simple drug group : (20.37±1.96), (4.37±1.19), (2.80±0.55), (6.93±1.70), (5.17±1.09), (15.50±2.69), (10.73±1.55); drug+ low-frequency group: (23.83±2.32), (5.87±0.94), (3.87±0.73), (9.17±1.74), (8.13±1.50), (20.77±2.19), (13.30±1.73); drug+ high-frequency group: (27.17±1.64), (6.73±1.01), (4.80±0.81), (11.20±2.06), (10.03±1.54), (25.17±3.14), (15.87±2.05)) (all P<0.05). Further analysis showed that both the drug+ low-frequency and drug+ high-frequency groups had higher scores than the simple drug group, and the drug+ high-frequency group had higher scores than the drug+ low-frequency group(all P<0.05). Conclusion:The combination of drug+ low-frequency or drug+ high-frequency rTMS and drug therapy can help improve cognitive function in patients with PD, and the efficacy of drug+ high-frequency rTMS may be more significant, which provides a new therapeutic idea for clinical treatment of patients with PD.

Effects of repetitive transcranial magnetic stimulation on learning-memory and synaptic plasticity in hippocampus of rats with post-stroke sleep deprivation / 中华行为医学与脑科学杂志

Objective:To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on learning-memory and the expression of synaptic plasticity proteins in hippocampus of rats with post-stroke sleep deprivation.Methods:A total of 28 SPF grade healthy male Wistar rats with 8-week old were randomly divided into four groups (control group, sham operation group, model group and rTMS group) according to random number table method, with 7 rats in each group. The rats in the model group and the rTMS group were treated with middle cerebral artery occlusion and p-chlorophenylalanine intraperitoneal injection to establish the post-stroke sleep deprivation model. The rats in the rTMS group were treated with rTMS intervention for consecutive 14 days after modeling. The rats in the sham operation group were only separated arteries but not ligated and inserted. The rats in control group were fed normally. The open field test (OFT) was used to observe the autonomous behavior of rats.The water maze test(WMT) was used to observe the spatial learning and memory ability of rats.The content of tyrosine kinase receptor type B(TrkB) in hippocampus was detected by Western blot.The expressions of brain-derived neurotrophic factor(BDNF) and immediate early gene c-fos in hippocampus were detected by immunofluorescence.The morphology and structure of neurons in hippocampus were observed by optical microscopy and transmission electron microscopy. SPSS 21.0 software was used for statistical analysis, and repeated measurement ANOVA was used for the escape latency data, one-way ANOVA was used for the comparison of other data among multiple groups, and LSD test was used for further pairwise comparison.Results:(1) The OFT results showed that there were statistical differences in the numbers of crossing squares, upright times and total points of rats in the four groups after intervention ( F=27.638, 10.425, 30.690, all P<0.001). The numbers of crossing squares ((72.71±10.10)), upright times ((6.57±0.87)times) and total points ((79.29±10.03) points) of rats in rTMS group were all higher than those in model group after intervention ((43.71±6.96), (3.43±0.65)times, (47.14±6.82)points) (all P<0.05). As for the escape latency of WMT among the four groups of rats, the interaction effect was not significant( F=1.108, P=0.37), and the time main effect( Ftime=27.295, Ptime<0.01) and group main effect ( Fgroup=8.691, Pgroup<0.01) were significant after rTMS intervention.On the 3rd and 4th day, the escape latency of rTMS group rats was lower than that of the model group (both P<0.01). There were statistically significant differences in the numbers of crossing platform, swimming distance and residence time in target quadrant of rats in the four groups after intervention( F=8.569, 3.308, 3.547, all P<0.05). The numbers of crossing platform ((2.00±0.31)times), swimming distance in target quadrant ((196.95±24.57) cm) and residence time ((17.72±1.36)s) of rats in rTMS group were all higher than those in model group after intervention ((1.57±0.30)times, (146.61±4.79) cm, (13.58±0.98)s)(all P<0.05). (2)Optical microscopy and transmission electron microscopy showed that the hippocampal cells arranged irregularly, the organelles' integrity was destroyed in the model group compared with the normal control group. In rTMS group the arrangement and structure of nerve cells in the hippocampus were improved after rTMS intervention. (3) The immunofluorescence results showed that c-fos (1.49±0.09) and BDNF (0.84±0.06) in the hippocampus of rats in rTMS group were both higher than those in model group ((1.24±0.12), (0.48±0.08))(both P<0.05). The Western blot results showed that the expression level of TrkB (1.81±0.03) in the hippocampus of rats in rTMS group was higher than that in model group (0.96±0.02) ( P<0.05). Conclusion:The rTMS can improve the learning-memory ability and autonomous capacity of rats with post-stroke sleep deprivation, which may be related to promoting the expression of c-fos, BDNF and TrkB in hippocampus tissue.

Effect of Combined Frequency Stimulation on The Electrophysiology of Granule Neurons in The Hippocampal Dentate Gyrus Area of Hindlimb Unloading Mice / 生物化学与生物物理进展

ObjectiveIn recent years, the negative impact of microgravity on astronauts’ nervous systems has received widespread attention. The repetitive transcranial magnetic stimulation (rTMS) technology has shown significant positive effects in the treatment of neurological and psychiatric disorders. The potential benefits of combined frequency stimulation (CFS) which combines different frequency stimulation patterns in ameliorating neurological dysfunctions induced by the microgravity environment, still require in-depth investigation. Exploring the therapeutic effects and electrophysiological mechanisms of CFS in improving various neurological disorders caused by microgravity holds significant importance for neuroscience and the clinical application of magnetic stimulation. MethodsThis study employed 40 C57BL/6 mice, randomly divided into 5 groups: sham group, hindlimb unloading (HU) group, 10 Hz group, 20 Hz group, and combined frequency stimulation (10 Hz+20 Hz, CFS) group. Mice in all groups except the sham group received 14 d of simulated microgravity conditions along with 14 d of repetitive transcranial magnetic stimulation. The effects of CFS on negative emotions and spatial cognitive abilities were assessed through sucrose preference tests and water maze experiments. Finally, patch-clamp techniques were used to record action potentials, resting membrane potentials, and ion channel dynamics of granule neurons in the hippocampal dentate gyrus (DG) region. ResultsCompared to the single-frequency stimulation group, behavioral results indicated that the combined frequency stimulation (10 Hz+20 Hz) significantly improved cognitive impairments and negative emotions in simulated microgravity mice. Electrophysiological experiments revealed a decrease in excitability of granule neurons in the hippocampal DG region after HU manipulation, whereas the combined frequency stimulation notably enhanced neuronal excitability and improved the dynamic characteristics of voltage-gated Na+ and K+ channels. ConclusionThe repetitive transcranial magnetic stimulation with combined frequencies (10 Hz+20 Hz) effectively ameliorates cognitive impairments and negative emotions in simulated microgravity mice. This improvement is likely attributed to the influence of combined frequency stimulation on neuronal excitability and the dynamic characteristics of Na+ and K+ channels. Consequently, this study holds the promise to provide a theoretical basis for alleviating cognitive and emotional disorders induced by microgravity environments.

Efficacy of rTMS and CBT-I on patients with chronic insomnia disorder： a randomized controlled study / 四川精神卫生

BackgroundTo date， pharmacologic therapy is considered the standard first-line treatment for insomnia disorder， but there are still some concerns over the adverse reactions. Repetitive transcranial magnetic stimulation （rTMS） and cognitive behavioral therapy for insomnia （CBT-I） as an alternative to pharmacologic therapy have the advantages of fewer side effects and better patient tolerance in the treatment of chronic insomnia disorder. ObjectiveTo explore the clinical efficacy of rTMS and CBT-I on chronic insomnia disorder， so as to provide a novel therapeutic option for the treatment of chronic insomnia disorder. MethodsA total of 50 patients with chronic insomnia disorder attending the outpatient clinic of Inner Mongolia Autonomous Region Mental Health Center or community hospital from September 21， 2020 to December 16， 2021 and fulfilling the International Classification of Sleep Disorders， third edition （ICSD-3） diagnostic criteria were enrolled. Additionally， 16 age- and sex-matched healthy controls recruited from the community were set as control group. Patients were randomly divided into rTMS group and CBT-I group， 25 cases in each group， and received rTMS or CBT-I intervention for 6 weeks respectively. At enrollment and completion of intervention， patients were subjected to Polysomnography （PSG）， Pittsburgh Sleep Quality Index （PSQI）， Insomnia Severity Index （ISI） and Repeatable Battery for the Assessment of Neuropsychological Status （RBANS）. All participants underwent resting-state functional magnetic resonance imaging （rs-fMRI） scans， and amplitude of low-frequency fluctuation （ALFF） was calculated. The brain regions with statistically different ALFF values between patient group and control group were chosen as regions of interest （ROIs）， and whole-brain seed-based functional connectivity analyses were conducted. ResultsAfter a 6-week intervention in the two groups， the main effect of time was significant for PSQI （F=41.160， P<0.05）， ISI （F=69.615， P<0.05） and RBANS immediate memory （F=47.923， P<0.05）， language （F=12.090， P<0.05） and delayed memory indices （F=28.193， P<0.05）. A significant main effect of time for total sleep time （F=8.995， P<0.05）， a significant main effect of time for sleep efficiency （F=12.414， P<0.05）， a significant main effect of group for sleep efficiency （F=4.342， P<0.05） and a significant main effect of time for N1% （F=7.806， P<0.05） were observed. Sleep efficacy in CBT-I group improved significantly from pre- to post-test （t=-2.785， P<0.05）. Patients in rTMS group showed increased functional connectivity between the orbital superior frontal gyrus and other regions including left lentiform nucleus putamen （t=4.991， P<0.05）， right median cingulate and paracingulate gyri （t=4.471， P<0.05） and right postcentral gyrus （t=4.922， P<0.05）， and increased functional connectivity between the orbital superior frontal gyrus and left middle frontal gyrus was found in CBT-I group （t=6.586， P<0.05）. ConclusionrTMS and CBT-I may help alleviate insomnia and improve cognitive function of patients with chronic insomnia disorder. [Funded by Science and Technology Planning Projects in Inner Mongolia Autonomous Region （number， 201802142）］

Kaiqiao Jieyin acupuncture combined with repetitive transcranial magnetic stimulation for post-stroke aphasia: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of Kaiqiao Jieyin acupuncture (acupuncture for opening orifices and relieving aphasia) combined with repetitive transcranial magnetic stimulation (rTMS) on language ability and daily life communication ability in patients with post-stroke aphasia (PSA).@*METHODS@#Fifty-six patients with PSA were randomly divided into an observation group and a control group, 28 cases in each group. Both groups received routine symptomatic treatment. The control group was treated with speech rehabilitation training and rTMS. On the basis of the treatment in the control group, the observation group was treated with Kaiqiao Jieyin acupuncture at the speech area Ⅰ, Fengchi (GB 20), Tongli (HT 5), Lianquan (CV 23), Panglianquan (Extra), etc. Panglianquan (Extra) on both sides were connected to electroacupuncture, with intermittent wave, 2 Hz in frequency. The above treatment was performed once a day for 5 consecutive days, followed by 2 days of rest for 2 weeks. The scores of western aphasia battery (WAB, including scores of spontaneous speech, auditory comprehension, repetition, naming and score of aphasia quotient [AQ]) and communication abilities in daily living (CADL) in the two groups were compared before and after treatment.@*RESULTS@#After treatment, the spontaneous speech, auditory comprehension, repetition, naming scores and AQ scores in both groups were higher than those before treatment (P<0.05), and the increase in the observation group was greater than the control group (P<0.05). The CADL scores of the two groups were higher than those before treatment (P<0.05).@*CONCLUSION@#Kaiqiao Jieyin acupuncture combined with rTMS can improve the language ability and daily life communication ability of PSA patients.

Effects of repetitive transcranial magnetic stimulation on neuronal excitability and ion channels in hindlimb unloading mice / 生物医学工程学杂志

Weightlessness in the space environment affects astronauts' learning memory and cognitive function. Repetitive transcranial magnetic stimulation has been shown to be effective in improving cognitive dysfunction. In this study, we investigated the effects of repetitive transcranial magnetic stimulation on neural excitability and ion channels in simulated weightlessness mice from a neurophysiological perspective. Young C57 mice were divided into control, hindlimb unloading and magnetic stimulation groups. The mice in the hindlimb unloading and magnetic stimulation groups were treated with hindlimb unloading for 14 days to establish a simulated weightlessness model, while the mice in the magnetic stimulation group were subjected to 14 days of repetitive transcranial magnetic stimulation. Using isolated brain slice patch clamp experiments, the relevant indexes of action potential and the kinetic property changes of voltage-gated sodium and potassium channels were detected to analyze the excitability of neurons and their ion channel mechanisms. The results showed that the behavioral cognitive ability and neuronal excitability of the mice decreased significantly with hindlimb unloading. Repetitive transcranial magnetic stimulation could significantly improve the cognitive impairment and neuroelectrophysiological indexes of the hindlimb unloading mice. Repetitive transcranial magnetic stimulation may change the activation, inactivation and reactivation process of sodium and potassium ion channels by promoting sodium ion outflow and inhibiting potassium ion, and affect the dynamic characteristics of ion channels, so as to enhance the excitability of single neurons and improve the cognitive damage and spatial memory ability of hindlimb unloading mice.

Effect of low frequency or high frequency repetitive transcranial magnetic stimulation on stroke patients with nonfluent aphasia / 中国康复理论与实践

ObjectiveTo explore the effect of low frequency or high frequency repetitive transcranial magnetic stimulation (rTMS) on right Broca's homologue in stroke patients with nonfluent aphasia. MethodsFrom January, 2019 to August, 2022, 80 inpatients in Beijing Bo'ai Hospital were randomly divided into control group (n = 20), sham stimulation group (n = 20), low-frequency (1 Hz) rTMS (LF-rTMS) group (n = 20) and high-frequency (10 Hz) rTMS (HF-rTMS) group (n = 20). All the patients received routine language therapy. LF-rTMS group and HF-rTMS group received ten days of rTMS (1 Hz or 10 Hz), and the sham group received ten days of sham rTMS. The Western Aphasia Battery (WAB) was used to evaluate the language function before, after treatment, and two months after treatment. ResultsBefore treatment, there was no significant difference in the scores of WAB among four groups (P > 0.05). All the scores improved in the four groups immediately after treatment and two months after treatment (P < 0.05). Compared with immediately after treatment, all the scores of WAB improved in LF-rTMS group (P < 0.05), and the scores of recall, name and aphasia quotient (AQ) improved in HF-rTMS group (P < 0.05) two months after treatment. Immediately after treatment, the scores of content and fluency, auditory comprehension and AQ were higher in LF-rTMS group than in HF-rTMS group (P < 0.05). Two months after treatment, the scores of content and fluency were higher in LF-rTMS group than in HF-rTMS group (P < 0.05). ConclusionBoth 1 Hz and 10 Hz rTMS could improve the language function of stroke patients with nonfluent aphasia, especially 1 Hz.

Effect of low frequency repetitive transcranial magnetic stimulation combined with bilateral isokinematic training on upper limb motor function of stroke patients / 中国康复理论与实践

ObjectiveTo explore low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with bilateral isokinematic training (BIT) on upper limb motor function and activities of daily living of stroke patients. MethodsFrom September, 2021 to September, 2022, 60 stroke inpatients in Zhejiang Provincial People's Hospital were randomly divided into rTMS group (n = 20), BIT group (n = 20) and combination group (n = 20). All the patients accepted routine rehabilitation, moreover, rTMS group accepted 1 Hz rTMS on healthy side, BIT group accepted BIT, and the combination group accepted the combination of 1 Hz rTMS on healthy side and BIT, for four weeks. They were evaluated with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), Carroll Upper Extremities Function Test (UEFT) and modified Barthel Index (MBI) before and after treatment. ResultsThe scores of FMA-UE, WMFT, UEFT and MBI significantly improved in all the groups after treatment (|t| > 5.052, P < 0.001), and improved the most in the combination group (F > 9.834, P < 0.001). ConclusionBoth low-frequency rTMS and BIT can effectively improve upper limb motor function and activities of daily living of stroke patients, and the combination of them is more effective.

Effect of proprioceptive neuromuscular facilitation rope training and repetitive transcranial magnetic stimulation on upper limb motor function of stroke patients with hemiplegia / 中国康复理论与实践

ObjectiveTo investigate the effect of combination of proprioceptive neuromuscular facilitation (PNF) rope training and repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function of stroke patients with hemiplegia. MethodsFrom March, 2021 to February, 2022, 90 stroke inpatients with hemiplegia in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangxi Medical University were divided into control group (n = 30), rope group (n = 30) and combination group (n = 30) randomly. All the groups received routine rehabilitation, while the control group received routine PNF training, the rope group received PNF rope training, and the combination group received PNF rope training and rTMS, for four weeks. They were assessed with Functional Test for the Hemiplegic Upper Extremity-Hong Kong version (FTHUE-HK), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. ResultsThe scores of FTHUE-HK, FMA-UE and MBI increased in all the three groups after treatment (t > 2.167, P < 0.05), and they were more in the combination group than in the rope group (P < 0.05), and in the rope group than in the control group (P < 0.05). ConclusionThe combination of PNF rope training and rTMS is more effective on motor function of upper limbs of stroke patients with hemiplegia than PNF training alone.

Repetitive transcranial magnetic stimulation for lower limb dysfunction post stroke: a scoping review / 中国康复理论与实践

ObjectiveTo summarize and analyze the protocols of repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke lower limb dysfunction. MethodsLiterature about rTMS for lower limb dysfunction of patients post stroke were retrieved from Web of Science, PubMed, CNKI, and Wanfang Data from inception to August 17, 2022. The quality of the literature was evaluated with Physiotherapy Evidence Database (PEDro) scale. Literature quality, data extraction and scoping review were performed by two researchers. ResultsA total of 21 studies were included, in which 20 studies suggested that rTMS treatment could promote the recovery of lower limb motor function after stroke. One study showed negative result. rTMS interventions were reported safe, with no serious adverse reactions. There were great heterogeneity in the demographic and clinical information, study protocols, stimulation parameters, coil types, targets of stimulation, and motor-evoked potential measurement in the included studies. ConclusionThe future protocols of rTMS need to be combined with stroke stage and severity of injury. There is a demand for more real vs. sham rTMS studies, reporting similar designs with sufficient information, to achieve a significant level of evidence regarding the use of rTMS in post-stroke patients.

Effect of rTMS on the efficacy and cognitive function of adolescents with depression / 四川精神卫生

ObjectiveTo investigate the effects of repetitive transcranial magnetic stimulation （rTMS） on the efficacy and cognitive function of adolescents with depression. MethodsA total of sixty adolescent depression patients who met the diagnostic criteria of the International Classification of Diseases， tenth edition （ICD-10） and were admitted to the psychological outpatient clinic of the Affiliated Hospital of North China University of Technology from September 2021 to March 2022 were selected for the study， and the random number table method was used to divide the study group （escitalopram oxalate combined with rTMS treatment） and a control group （escitalopram oxalate combined with rTMS pseudo-stimulation treatment） of 30 cases each， and both groups were treated for 4 weeks. Before treatment and at 1， 2， 3 and 4 weeks of treatment， patients' depressive symptoms were assessed using the scores and subtraction rates of the Hamilton Depression Scale-24 item （HAMD-24）， and before treatment and after 4 weeks of treatment， cognitive function was assessed using the Motion Screening Task （MOT）， Rule Switch Task （RST） and Delayed Matching-to-Sample （DMS） task of the Zhiyun Neuropsychological Automated Test System assessment. Adverse effects during treatment were recorded in both groups. ResultsRepeated measures ANOVA results showed statistically significant time main effects， group main effects， and the interaction between the two groups for HAMD-24 scores before treatment and after 1， 2， 3 and 4 weeks of treatment in patients （F=522.021， 39.905， 26.412， P<0.05）. Individual effect analysis showed statistically significant differences in HAMD-24 scores between the two groups after 2， 3 and 4 weeks of treatment （t=-12.784~-2.776， P<0.01）. After 4 weeks of treatment， the total effective rate of treatment in the study group was higher than that in the control group （93.33% vs. 73.33%， χ2=4.320， P<0.05）， and the differences in each indicator of RST and DMS between the two groups were statistically significant compared with those before treatment （t=-5.616~9.135， P<0.05 or 0.01）， and the differences between the two groups were statistically significant （t=-4.823~5.518， P<0.05 or 0.01）. ConclusionrTMS may help improve depressive symptoms as well as cognitive function in adolescents with depression.

The basis and clinical research progress of repetitive transcranial magnetic stimulation in the treatment of pediatric epilepsy / 中华实用儿科临床杂志

Epilepsy is a common neurological disease, which is caused by transient brain dysfunction due to sudden abnormal discharges of neurons.Repetitive transcranial magnetic stimulation (rTMS) is a neuroelectrophysiological technique developed based on transcranial magnetic stimulation that regulates the excitability of the cerebral cortex, presenting the advantages of painless, non-invasiveness, good safety and less adverse events.In addition, rTMS is widely used in experimental research and clinical treatment, which has a high efficacy on the treatment of central nervous system diseases, and important value for the detection and treatment of pediatric epilepsy.This paper reviews the principle, mechanism, application and safety of rTMS in the treatment of pediatric epilepsy.