Objective

To investigate the mechanisms underlying the effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke hemiplegia, we assessed alterations in cerebral glucose metabolism.

Methods

Five post-stroke hemiplegic patients (three targeted for upper limb impairment and two targeted for lower limb impairment) aged 62.6 ± 6.1 years (mean ± standard deviation) with a duration since stroke onset of 3.5 ± 3.8 years participated in this preliminary study. Cerebral glucose metabolism was measured twice—before and after rTMS with intensive rehabilitation—using positron emission tomography with [18F]fluorodeoxyglucose. The Asymmetry Index (AI) was calculated to assess laterality of metabolism between the lesional and contralesional motor areas. The alteration rates of AI (%ΔAI) were compared between participants in whom rTMS was effective and ineffective.

Results

Two of the three upper-limb-targeted patients and one of the two lower-limb-targeted patients showed motor function improvements following rTMS treatment. All three patients who responded to rTMS had improved laterality of cerebral glucose metabolism in motor areas, commonly in the precentral gyrus, with an %ΔAI of approximately 10%. In contrast, the two patients who did not respond to rTMS had no improvements in laterality.

Conclusions

These results suggest for the first time that improved glucose metabolism is associated with improved motor function after a combination of rTMS and intensive rehabilitation.

中文翻译：

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重复经颅磁刺激对脑糖代谢的影响

目标

为了研究重复经颅磁刺激 (rTMS) 对中风后偏瘫影响的潜在机制，我们评估了脑葡萄糖代谢的改变。

方法

5 名中风后偏瘫患者（3 名针对上肢损伤，2 名针对下肢损伤）年龄 62.6 ± 6.1 岁（平均值 ± 标准差），中风发作后的持续时间为 3.5 ± 3.8 年，参与了这项初步研究。使用正电子发射断层扫描和 [18F] 氟脱氧葡萄糖测量两次脑葡萄糖代谢 - 在 rTMS 强化康复之前和之后。计算不对称指数 (AI) 以评估病变和对侧运动区域之间代谢的侧向性。比较 rTMS 有效和无效的参与者之间的 AI 改变率 (%ΔAI)。

结果

三名上肢靶向患者中的两名和两名下肢靶向患者中的一名在 rTMS 治疗后表现出运动功能改善。对 rTMS 有反应的所有三名患者都改善了运动区脑葡萄糖代谢的偏侧性，通常在中央前回，%ΔAI 约为 10%。相比之下，对 rTMS 没有反应的两名患者在偏侧性方面没有改善。

结论

这些结果首次表明，在 rTMS 和强化康复相结合后，改善的葡萄糖代谢与改善的运动功能有关。