关键词: 急性缺血性脑卒中, 重复经颅磁刺激, 手部功能, 静息态功能磁共振, 功能网络

Abstract: Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) applied to the thumb motor cortex representation area on hand function in patients with acute ischemic stroke. Methods A total of 78 patients in the acute phase of ischemic stroke admitted to our hospital between July 2023 and March 2024 were included as study subjects.These patients were divided into two groups based on different treatment methods:an experimental group (n=46) that received high-frequency repetitive transcranial magnetic stimulation (rTMS) treatment and a control group (n=32) that underwent sham rTMS treatment.Evaluations were conducted after 10 days of treatment.Clinical efficacy was compared between the two groups.Pre-treatment and post-treatment (10 days) data on neurologic deficit scores,active range of motion (AROM) of the wrist and hand joints,simplified Fugl-Meyer Assessment (FMA) for hand function,MBI and MEP were collected.Resting-state functional magnetic resonance imaging (fMRI) scans were acquired before and 10 days after treatment.Independent component analysis (ICA) and seed-based functional network analysis were used to extract resting-state motor networks and assess the functional connectivity within these networks.Changes in the motor function network and intranetwork node connectivity were compared between pre- and post-treatment conditions for both groups and between the two groups post-treatment. Results The total effective rate of experimental group was 89.13%,which was significantly higher than that of control group (68.75%) (P＜0.05).There were no significant differences between the two groups in terms of neurologic deficit scores,FMA scores,AROM parameters,and sEMG parameters before treatment (P＞0.05).After 10 days of treatment,the experimental group showed significantly greater improvements in neurologic deficit scores,FMA scores,AROM parameters,MBI and MEP compared to the control group (P＜0.05).Resting-state motor network analysis revealed that high-frequency rTMS treatment led to significantly enhanced functional connectivity in the affected side's precentral gyrus,postcentral gyrus,supplementary motor area (SMA),and contralateral postcentral gyrus in the experimental group (P＜0.05,corrected by Alphasim).In contrast,the control group demonstrated increased functional connectivity in the contralateral precentral gyrus,contralateral middle frontal gyrus,and bilateral SMA (P＜0.05,corrected by Alphasim).Compared to the control group,the experimental group exhibited more pronounced increases in functional connectivity in the bilateral precentral gyri,bilateral SMA,ipsilateral middle frontal gyrus,and contralateral postcentral gyrus.However,the impact of high-frequency rTMS on functional connectivity in the contralateral middle frontal gyrus was weaker (P＜0.05,corrected by Alphasim).Functional connectivity between various motor-related brain regions was significantly enhanced in the experimental group after rTMS treatment,particularly between the ipsilateral M1 and ipsilateral/contralateral SMA,the ipsilateral SMA and ipsilateral M1/PMA,the ipsilateral PMA and ipsilateral SMA/contralateral M1,the contralateral M1 and ipsilateral S/PMA,and the contralateral SMA and ipsilateral M1/PMA (P＜0.05).No such significant enhancements were observed in the control group (P＞0.05). Conclusion High-frequency rTMS can effectively improve hand function in patients with acute ischemic stroke,likely due to its ability to enhance the connectivity of the hand motor function network,promote recovery of the affected hemisphere's motor function network,and improve the coordination of functional connectivity between nodes in the affected and unaffected hemispheres.

Key words: Acute ischemic stroke, Repetitive transcranial magnetic stimulation, Hand function, Resting-state functional MRI, Functional network