Combining inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment improves motor function by modulating GABA in acute ischemic stroke patients

2021 ◽  
pp. 1-16
Author(s):  
Qing-Mei Chen ◽  
Fei-Rong Yao ◽  
Hai-Wei Sun ◽  
Zhi-Guo Chen ◽  
Jun Ke ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Motor Function ◽  
Magnetic Stimulation ◽  
Sham Group ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Dysfunction ◽  
Gaba Level ◽  
Stroke Patients ◽  
Before And After

Background: The combination of inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) can improve motor function of stroke patients with undefined mechanism. It has been demonstrated that rTMS exhibits a neuro-modulatory effect by regulating the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) in other diseases. Objectives: To evaluate the effect of combined inhibitory and facilitatory rTMS on GABA in the primary motor cortex (M1) for treating motor dysfunction after acute ischemic stroke. Methods: 44 ischemic stroke patients with motor dysfunction were randomly divided into two groups. The treatment group was stimulated with 10 Hz rTMS at the ipsilesional M1 and 1 Hz rTMS at the contralesional M1. The sham group received bilateral sham stimulation at the motor cortices. The GABA level in the bilateral M1 was measured by proton magnetic resonance spectroscopy (1H-MRS) at 24 hours before and after rTMS stimulation. Motor function was measured using the Fugl-Meyer Assessment (FMA). The clinical assessments were performed before and after rTMS and after 3 months. Results: The treatment group exhibited a greater improvement in motor function 24 hours after rTMS compared to the sham group. The increased improvement in motor function lasted for at least 3 months after treatment. Following 4 weeks of rTMS, the GABA level in the ipsilesional M1 of the treatment group was significantly decreased compared to the sham group. Furthermore, the change of FMA score for motor function was negatively correlated to the change of the GABA:Cr ratio. Finally, the effect of rTMS on motor function outcome was partially mediated by GABA level change in response to the treatment (27.7%). Conclusions: Combining inhibitory and facilitatory rTMS can decrease the GABA level in M1, which is correlated to the improvement of motor function. Thus, the GABA level in M1 may be a potential biomarker for treatment strategy decisions regarding rTMS neuromodulatory interventions.

scholarly journals PENGARUH REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) TERHADAP GANGGUAN FUNGSI KOGNITIF PASCASTROKE ISKEMIK

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Novika Azirah Azis ◽  
Jumraini Tammasse ◽  
Abdul Muis
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Transcranial Magnetic Stimulation ◽  
Treatment Group ◽  
Medical Therapy ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Chi Square

  THE INFLUENCE OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (RTMS) TOWARDS IMPAIRED COGNITIVE FUNCTION AFTER ISCHEMIC STROKEABSTRACTIntroduction: The increasing number of ischemic stroke patients who experience memory disturbances and a long rehabilitation process requires an innovation that can strengthen both existing therapies (medical therapy) and non-invasive stimulation of cognitive rehabilitation in the form of repetitive transcranial magnetic stimulation (rTMS).Aim: To determine effectiveness of rTMS towards impaired cognitive function in ischemic stroke.Methods: This research was conducted using experimental with open clinical trial test method  on ischemic stroke patients suffering from cognitive impairment at Wahidin Sudirohusodo Hospital and Inggit Clinic, Makassar, from November 2018 until January 2019. Samples were divided into control who was given only medical therapy and treatment group who was given medical therapy and rTMS. Stimulation is given in the form of a high frequency of 10Hz in 2 cycles for 5 consecutive days with a gap of 2 days. MoCA-Ina was used to assess cognitive impairment. The assessment were made on day-1 before therapy and day-15 after therapy. The statistical analysis of correlation among variables was conducted by using Chi-square test with value of p <0.05 which was considered significant.Results: There were 22 samples, 11 in each group. The difference of MoCA-Ina scores in both groups with the final average after 15 days of treatment was 5.27 in the treatment group and 1.45 in control group. This difference is considered significant with the p value of 0.003.Discussion: There was an effect of rTMS therapy on cognitive function disorders after ischemic stroke, in which the change was greater in the treatment group than in the control group.Keywords: Cognitive impairment, ischemic stroke, Montreal Cognitive Assesment Indonesian Version (MoCA-Ina), repetitive transcranial magnetic stimulation (rTMS)ABSTRAKPendahuluan: Peningkatan jumlah pasien stroke iskemik yang mengalami gangguan memori serta proses rehabilitasi yang lama membutuhkan suatu inovasi yang dapat saling menguatkan antara terapi yang sudah ada (terapi medik) dan stimulasi non-invasif rehabilitasi kognitif berupa repetitive transcranial magnetic stimulation (rTMS).Tujuan: Mengetahui pengaruh intervensi rTMS terhadap fungsi kognitif pascastroke iskemik.Metode: Penelitian eksperimental dengan uji klinis terbuka terhadap pasien stroke iskemik yang menderita gangguan fungsi kognitif di RSUP Dr. Wahidin Sudirohusodo dan Klinik Inggit Medika, Makassar, pada bulan November 2018 hingga Januari 2019. Subjek dibagi ke dalam kelompok kontrol yang diberikan terapi medikamentosa saja serta kelompok perlakuan yang diberikan terapi medikamentosa dan intervensi rTMS. Stimulasi diberikan berupa frekuensi tinggi 10Hz dalam 2 siklus selama 5 hari berturut-turut dengan jeda waktu 2 hari. Penilaian gangguan kognitif menggunakan Montreal Cognitive Assesment versi Indonesia (MoCA-Ina). Pengukuran dilakukan pada hari-1 pre-terapi dan hari ke-15 pascaterapi. Data dianalisis secara statistik menggunakan uji Chi-square dengan nilai p<0,05 dianggap bermakna.Hasil: Terdapat 22 subjek yang masing-masing terdiri dari 11 subjek pada kelompok kontrol dan perlakuan. Selisih skor MoCA-Ina pada kedua kelompok dengan rerata akhir setelah lima belas hari perlakuan sebesar 5,27 pada kelompok perlakuan dan 1,45 pada kelompok kontrol yang bermakna (p=0,003).Diskusi: Terdapat pengaruh terapi rTMS terhadap gangguan fungsi kognitif pascastroke yang lebih besar pada kelompok perlakuan dibanding kelompok kontrol.Kata kunci: Gangguan kognitif, Montreal Cognitive Assesment versi Indonesia (MoCA-Ina), repetitive transcranial magnetic stimulation (rTMS), stroke iskemik  

Role of d-serine in the beneficial effects of repetitive transcranial magnetic stimulation in post-stroke patients

2020 ◽  
Vol 32 (3) ◽  
pp. 128-134 ◽  
Author(s):  
Masachika Niimi ◽  
Yuko Fujita ◽  
Tamaki Ishima ◽  
Kenji Hashimoto ◽  
Nobuyuki Sasaki ◽  
...  
Keyword(s):  
Amino Acids ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Beneficial Effects ◽  
Depressed Patients ◽  
Before And After ◽  
The Impact

AbstractObjective:Abnormalities in neurotransmission via N-methyl-d-aspartic acid receptor (NMDAR) play a role in the pathophysiology of neuropsychiatric disorders. The impact of repetitive transcranial magnetic stimulation (rTMS) on NMDAR-related amino acids remains unknown. We aim to investigate the effects of rTMS on NMDAR-related amino acids in serum of post-stroke patients.Methods:Ninety-five consecutive post-stroke patients with upper limb hemiparesis were recruited. In 27 patients, the Beck Depression Inventory (BDI) score was 10 or higher. Twelve depressed patients underwent rehabilitation in combination with rTMS and 15 non-depressed patients underwent rehabilitation only without rTMS for 14 days. 1 Hz rTMS was applied to the primary motor area in the non-lesional hemisphere. BDI was conducted before and after treatment. Serum glutamine, glutamate, glycine, l-serine, and d-serine levels were measured before and after treatment.Results:There were no differences between depressed patients and non-depressed patients in clinical characteristics, levels of the five amino acids in serum, and the ratio of amino acids. However, in 27 depressed patients, there was a significant correlation between levels of glutamate in serum and BDI (ρ = 0.428, p = 0.026). BDI decreased significantly in depressed patients after treatment with or without rTMS. d-serine decreased in the rehabilitation with rTMS group, but increased in the rehabilitation without rTMS group. l-serine increased in the rehabilitation with rTMS group, but decreased in the rehabilitation without rTMS group.Conclusion:The results suggest that rTMS can modulate NMDAR-related amino acids in blood, producing beneficial effects.

scholarly journals The Effect of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation Therapy on Serum Brain-Derived Neurotropic Factor Level and Motor Ability in Ischemic Stroke Patients: A Single-Center Study

2020 ◽  
Vol 8 (B) ◽  
pp. 198-204
Author(s):  
Andi Kurnia Bintang ◽  
Muhammad Akbar ◽  
Muhammad Yunus Amran ◽  
Nurussyariah Hammado
Keyword(s):  
Ischemic Stroke ◽  
Motor Skills ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Low Frequency ◽  
Motor Ability ◽  
Stroke Patients ◽  
Motor Abilities ◽  
Neurotropic Factor ◽  
Serum Bdnf

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) is widely used in various neurological cases. rTMS is an effective method of restoration in patients with disability due to central nervous system disorder. AIM: This study aimed to determine the effect of high and low frequency of rTMS on serum brain-derived neurotropic factor (BDNF) levels and motoric abilities in ischemic stroke patients. METHODS: The study design was an experiment with a purposive sampling consecutive on 27 samples with the onset of ischemic stroke 6 months. The study was conducted from February to October 2018; samples were recruited from Neurology Ward of Wahidin Sudirohusodo hospital and its affiliating centers. The serial of rTMS intervention was delivered in “Brain” Clinic center. After fulfilling the inclusion criteria and the initial examination of serum BDNF and motor ability, samples were randomly divided into two groups, intervention group who received standard therapy with rTMS therapy (n = 14) and the control group who only received standard therapy (n = 13). rTMS was given for 2 min frequency of 1 Hertz (Hz) contralesion and 5 Hz ipsilesion every day for 10 days. Assessment of serum BDNF levels and motor skills was conducted on days 1 and 10 of the study. Serum BDNF levels were measured by the monoclonal antibody ELISA technique while motor skills were measured based on the score of the Stroke Rehabilitation Assessment of Movement (STREAM). Serum BDNF values and the STREAM delta score were compared between the two groups of samples. RESULTS: The results showed significant changes only occurred in motor abilities in both groups of samples after 10 days of rTMS therapy with the Wilcoxon test (p < 0.5). The Mann–Whitney U-test showed a more significant change (p < 0.5) in the treatment group than in the control (p = 0.5). CONCLUSION: rTMS has an effect on improving motor ability in ischemic stroke patients. This change in motor abilities is not related to serum BDNF levels in this study.

scholarly journals Effects of High-Frequency (HF) Repetitive Transcranial Magnetic Stimulation (rTMS) on Upper Extremity Motor Function in Stroke Patients: A Systematic Review

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1215
Author(s):  
Birute Vabalaite ◽  
Laura Petruseviciene ◽  
Raimondas Savickas ◽  
Raimondas Kubilius ◽  
Povilas Ignatavicius ◽  
...  
Keyword(s):  
Systematic Review ◽  
Transcranial Magnetic Stimulation ◽  
Upper Extremity ◽  
Motor Function ◽  
High Frequency ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Cochrane Library ◽  
Stroke Patients ◽  
Sham Stimulation

Background and Objectives: Repetitive transcranial magnetic stimulation (rTMS) is being widely used for treating upper extremity paresis after stroke, however, evidence of applying high-frequency rTMS (HF-rTMS) on the ipsilesional hemisphere for upper extremity motor recovery remains limited. This systematic review aimed to investigate the effect of high-frequency repetitive transcranial magnetic stimulation for upper extremity motor function recovery after a first-time ischaemic stroke. Materials and Methods: This systematic review was prepared according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. A comprehensive literature search was performed to identify all studies published before 12 February 2021. The search was performed on the following databases: PubMed, Ovid, The Cochrane Library. Results: A total of 6440 studies were found in the databases and four trials were included in the review. Three of the studies were randomized control trials (RCT), and one was a pseudo-RCT. Three of the studies showed good methodological quality and one study was rated as excellent. Fugl-Meyer Assessment (FMA) was performed in three out of four studies and the score significantly increased in the HF-rTMS treatment group compared with sham stimulation in all trials. Other measures used in the studies were handgrip strength, shoulder abduction, Motricity Index, Wolf Motor Function Test (WMFT), and Box and Block, although these tests did not show unanimous results. Overall, all four studies conveyed significantly better results in at least one test that was performed for hand motor function evaluation in a 10 Hz stimulation group while none of the tests showed any advantage for sham stimulation groups. Two studies reported headache as an adverse event (six patients in total). Conclusion: The overall results showed that HF-rTMS may increase impaired upper extremity motor function better than sham stimulation in stroke patients.

scholarly journals Distinction of High- and Low-Frequency Repetitive Transcranial Magnetic Stimulation on the Functional Reorganization of the Motor Network in Stroke Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Zhiwei Guo ◽  
Yu Jin ◽  
Xi Bai ◽  
Binghu Jiang ◽  
Lin He ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Functional Connectivity ◽  
Magnetic Stimulation ◽  
Sham Group ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Low Frequency ◽  
Stroke Patients ◽  
Functional Reorganization ◽  
Motor Network ◽  
Motor Improvement

Objective. To investigate the functional reorganization of the motor network after repetitive transcranial magnetic stimulation (rTMS) in stroke patients with motor dysfunction and the distinction between high-frequency rTMS (HF-rTMS) and low-frequency rTMS (LF-rTMS). Methods. Thirty-three subcortical stroke patients were enrolled and assigned to the HF-rTMS group, LF-rTMS group, and sham group. Each patient of rTMS groups received either 10.0 Hz rTMS over the ipsilesional primary motor cortex (M1) or 1.0 Hz rTMS over the contralesional M1 for 10 consecutive days. A resting-state functional magnetic resonance imaging (fMRI) scan and neurological examinations were performed at baseline and after rTMS. The motor network and functional connectivities intramotor network with the core brain regions including the bilateral M1, premotor area (PMA), and supplementary motor area (SMA) were calculated. Comparisons of functional connectivities and Pearson correlation analysis between functional connectivity changes and behavioral improvement were calculated. Results. Significant motor improvement was found after rTMS in all groups which was larger in two rTMS groups than in the sham group. The functional connectivities of the motor network were significantly increased in bilateral M1, SMA, and contralesional PMA after real rTMS. These changes were only detected in the regions of the ipsilesional hemisphere in the HF-rTMS group and in the regions of the contralesional hemisphere in the LF-rTMS group. Significantly changed functional connectivities of the intramotor network were found between the ipsilesional M1 and SMA and contralesional PMA, between contralesional M1 and contralesional SMA, between contralesional SMA and ipsilesional SMA and contralesional PMA in the HF-rTMS group in which the changed connectivity between ipsilesional M1 and contralesional PMA was obviously correlated with the motor improvement. In addition, the functional connectivity of the intramotor network between ipsilesional M1 and contralesional PMA was significantly higher in the HF-rTMS group than in the LF-rTMS group. Conclusion. Both HF-rTMS and LF-rTMS have a positive effect on motor recovery in patients with subcortical stroke and could promote the reorganization of the motor network. HF-rTMS may contribute more to the functional connectivity reorganization of the ipsilesional motor network and realize greater benefit to the motor recovery.

scholarly journals Effects of Excitatory Repetitive Transcranial Magnetic Stimulation of the P3 Point in Chronic Stroke Patients – Case Reports

2018 ◽  
Author(s):  
Ronaldo Luis da Silva ◽  
Angela Maria Costa de Souza ◽  
Francielly Ferreira Santos ◽  
Sueli Toshie Inoue ◽  
Johanne Higgins ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Motor Function ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Case Reports ◽  
Sensory Function ◽  
Stroke Patients ◽  
Chronic Patients ◽  
Stimulation Of

Objective: to evaluate the effects of excitatory repetitive transcranial magnetic stimulation (rTMS) of the international 10-20 system P3 point (intraparietal sulcus region) in chronic patients with a frontal lesion and parietal sparing due to stroke on the impaired upper (UL) and lower limb (LL) as measured by Fugl-Meyer Assessment (FMA). Methods: three patients (C1: 49.83/2.75, C2: 53.17/3.83, C3: 63.33/3.08 years-old at stroke/ years post-stroke, respectively) received two weeks (five days/ week) of rTMS at 10 Hz of P3. A patient was treated in similar conditions with a sham coil (S1: 56.58/4.33). No complimentary therapy was delivered during the study. Patients were evaluated before, after- and two months post-treatment (A1, A2 and A3, respectively). Results: we found increased scores for LL in motor function subsection for C1 and C3 and in sensory function for C2 by A2 that remained at A3. We also found an increased score for UL motor function for C2 and C3, but the score decreased by A3 for C2. C3 score for UL range of motion increased by A3 compared to A1 and A2. Conclusion: In a variable way, P3 excitatory rTMS increased FMA scores in different upper and lower limb subsections of our three treated patients.

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