Table_3_Effect of Cognition Recovery by Repetitive Transcranial Magnetic Stimulation on Ipsilesional Dorsolateral Prefrontal Cortex in Subacute Stroke Patients.docx

ObjectiveTo demonstrate the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the ipsilesional dorsolateral prefrontal cortex (DLPFC) on neurological recovery in patients with subacute phase stroke.
MethodsPatients with supratentorial hemispheric stroke who were hospitalized for intensive rehabilitation in the subacute phase were enrolled for this retrospective analysis. Two groups of patients were selected: the rTMS group who received high-frequency (20 Hz) rTMS ≥ 5 times over the ipsilesional DLPFC, and a control group who did not receive any rTMS. The patients were further divided into groups with right- or left-side brain lesions. Functional measurements for cognitive ability, mood, speech, and activities of daily living, which were assessed at baseline and at the 1-month follow-up as a routine clinical practice, were used for analyses.
ResultsAmong 270 patients with available clinical data, 133 (women, 51; age, 61.0 ± 13.8 years) met the inclusion criteria and were enrolled for analysis. There were no differences in demographic data and functional scores at baseline between the rTMS (n = 49) and control (n = 84) groups. The rTMS group showed a higher gain in the mini-mental status examination (MMSE) total score and subscores of all domains, forward digit span, and FIM-cognition than the control group (P < 0.05). Among the patients with left hemispheric lesions (n = 57), the rTMS group showed better outcomes in cognition and depression through scores of total and “attention and concentration” subscores of MMSE, FIM-cognition, and the geriatric depression scale (P < 0.05). Among the patients with right hemispheric lesions (n = 76), the rTMS group showed better outcomes in cognition through the MMSE total score and subscores of “attention and concentration,” “registration,” and “recall,” and scores of both forward and backward digit spans (P < 0.05).
ConclusionHigh-frequency rTMS over the ipsilesional DLPFC has beneficial effects on the recovery of cognition on both sides as well as mood in patients with left-sided hemispheric lesions.

研究目的：探讨针对病灶侧背外侧前额叶皮层（ipsilesional dorsolateral prefrontal cortex, DLPFC）实施高频重复经颅磁刺激（high-frequency repetitive transcranial magnetic stimulation, rTMS）对亚急性脑卒中患者神经功能恢复的疗效。

研究方法：本回顾性分析纳入亚急性阶段住院接受强化康复治疗的幕上半球性脑卒中患者。按干预方案将研究对象分为两组：rTMS组，即于病灶侧DLPFC接受≥5次20Hz高频rTMS治疗的患者；对照组，即未接受任何rTMS治疗的患者。进一步按脑病灶侧别划分为左侧半球病灶与右侧半球病灶亚组。分析采用临床常规评估、于基线及1个月随访时采集的认知功能、情绪、言语及日常生活活动能力评分数据。

研究结果：共计270例患者拥有完整临床数据，其中133例符合纳入标准并纳入最终分析（女性51例，年龄为61.0±13.8岁）。rTMS组（n=49）与对照组（n=84）的人口学资料及基线功能评分均无统计学差异。与对照组相比，rTMS组患者的简易精神状态检查表（mini-mental status examination, MMSE）总分及各维度子评分、数字顺向广度、FIM认知分量表得分提升更为显著（P<0.05）。在左侧半球病灶亚组（n=57）中，rTMS组患者在MMSE总分及“注意力与集中力”子评分、FIM认知分量表、老年抑郁量表评分方面，认知功能与抑郁症状改善效果更优（P<0.05）。在右侧半球病灶亚组（n=76）中，rTMS组患者的MMSE总分及“注意力与集中力”“定向”“回忆”子评分、数字顺向与逆向广度得分均显著更高，认知功能恢复更佳（P<0.05）。

研究结论：针对病灶侧DLPFC的高频rTMS对两侧脑卒中患者的认知功能恢复均具有积极作用，同时可改善左侧半球病灶患者的情绪状态。