简介：摘要ObjectiveTo determine the mechanisms on cognitive improvement with repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex(L-DLPFC) in subacute stroke patients.MethodsTwenty-eight first-ever stroke patients with cognitive impairment were recruited. All subjects were randomly assigned to real or sham stimulation group and completed 10 sessions of rTMS for 2 weeks. 10 Hz of navigation rTMS were applied (5 s stimulation and 25 s resting, total 1500 pulses) on the L-DLPFC at 80% of resting motor threshold (rMT). At the time of baseline, 1 month and 3 months after stroke onset, all subjects received the Korean-mini mental state examination (K-MMSE), Korean-Montreal Cognitive Assessment (K-MOCA), Upper Fugl-Meyer Assessment (U-FMA), Korean-Modified Bathel Index (K-MBI), European Quality of life 5 Dimension (EQ-5D), Korean-Geriatric Depression Scale (K-GDS). In addition, the continuous performance test (CPT), vascular cognitive impairment harmonization standards (VCIHS), motor evoked potentials (MEP), event-related potentials (ERPs), resting state functional magnetic resonance imaging (RS fMRI) and diffusion tensor imaging (DTI) were completed at baseline and 3 months after stroke onset.ResultsAfter the intervention period, the real stimulation group improved significantly in the K-MMSE, K-MOCA, K-MBI and K-GDS compared with sham stimulation group. And these effects lasted after three months in MOCA. There was no significant time × group effect among the U-FMA, EQ-5D, and CPT. Among the VCIHS parameters, Z-scores of executive and memory function showed higher delta value between baseline and 3months timepoints in rTMS group. The MEP showed higher TIME × GROUP interaction in the intracortical inhibition value on right hand. It suggests that there is beneficial effect on premotor cortical excitability of rTMS. The change of P300 amplitude on F3 and C3 was more increased in real stimulation group significantly only in the auditry Oddball paradigm. The RS fMRI analysis results showed more increased functional connectivity of Cingulate Gyrus, Supramarginal Gyrus, Cerebelum Crus2, Precentral gyrus, Middle temporal gyrus and Inferial temporal gyrus after stimulation compared with the sham group. Brain activation in the cingulum showed a tendency that after 3 months, fractional anisotropy (FA) and fiber number (FN) in real group were larger than sham group, however there was no significant effect. The relationship between the change of K-MOCA and fractional anisotropy of the cingulum was found positive correlation in all subjects.ConclusionsThese results suggest that high frequency rTMS on the L-DLPFC improves cognitive function and functional network activity in subacute stroke. The rTMS seems to be a recommendable treatment in stroke patients with cognitive impairment.

简介：摘要：目的：观察rTMS与tDCS联合治疗卒中后认知功能障碍患者的疗效，为该治疗提供实践基础，为探索治疗原理提供依据。方法：选取卒中后3个月到6个月之间诊断为PSCI的患者，分为rTMS组，tDCS组，联合治疗组以及对照组。给予常规药物及认知康复训练，于治疗前、治疗4周后进行评估。结论：通过临床实践和观察，证实rTMS与tDCS联合治疗效果强于传统康复加上其中某一种治疗方式。

简介：摘要：目的 分析重复经颅磁刺激（rTMS）在脑梗塞运动功能康复中的作用。方法 2021年10月～2022年12月，我院收治脑梗塞患者82例为研究观察对象，依据随机数字表法分2组，对照组（纳入常规功能训练患者41例）、观察组（纳入常规功能训练+rTMS干预患者41例），观察两组运动功能、生活能力、家属满意度情况。结果 观察组与对照组相比干预后肢体功能（FMA）、生活能力（Barthel指数）评分更高，组别差异显著（P＜0.05）；观察组同对照组相比干预后家属满意度更高，组别差异显著（P＜0.05）。结论 脑梗塞患者采用rTMS干预可以加速患者运动功能康复，改善患者生活能力，提高患者家属满意度。

简介：摘要本文综述了今年来应用重复经颅磁治疗（rTMS）抑郁障碍的研究，旨在为探讨抑郁障碍应用重复经颅磁治疗的疗效及安全性等。

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简介：摘要ObjectiveThe present study aimed to investigate the effects of rTMS on astrocytic polarization during cerebral ischemic/reperfusion injury.MethodsThree rTMS protocols were applied to primary astrocytes under normal and oxygen-glucose deprivation/reoxygenation (OGD/R) conditions. Cell survival, proliferation, and phenotypic changes were assessed after 2-day treatment. Astrocytes culture medium (ACM) from control, OGD/R, and OGD/R + rTMS groups were mixed with neuronal medium to culture neurons for 48 h and 7 days, in order to explore the influence on neuronal survival and synaptic plasticity. In vivo, rats were subjected to middle cerebral artery occlusion (MCAO), and received posterior orbital intravenous injection of ACM collected from different groups at reperfusion, and at 3 days post reperfusion. The apoptosis in the ischemic penumbra, infarct volumes, and the modified Neurological Severity Score (mNSS) were evaluated at 1 week after reperfusion, and cognitive functions were evaluated using the Morris Water Maze (MWM) tests. Finally, the 10 Hz rTMS was directly applied to MCAO rats to verify the rTMS effects on astrocytic polarizationResultsAmong these three frequencies, the 10 Hz protocol exerted the greatest potential to modulate astrocytic polarization after OGD/R injury. Classically activated and A1 markers were significantly inhibited by rTMS treatment. In OGD/R model, the concentration of pro-inflammatory mediator TNF-α decreased from 57.7 to 23.0 pg/mL, while anti-inflammatory mediator IL-10 increased from 99.0 to 555.1 pg/mL in the ACM after rTMS treatment. The ACM collected from rTMS-treated astrocytes significantly alleviated neuronal apoptosis induced by OGD/R injury, and promoted neuronal plasticity. In MCAO rat model, the ACM collected from rTMS treatment decreased neuronal apoptosis and infarct volumes, and improved cognitive functions. The neurotoxic astrocytes were simultaneously inhibited after rTMS treatment.ConclusionsInhibition of neurotoxic astrocytic polarization is a potential mechanism for the effectiveness of high-frequency rTMS in cerebral ischemic stroke.

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简介：摘要ObjectiveThis study aimed to evaluate the effect of different combinations of rTMS and cognitive training (rTMS-COG) on PSCI and identify the optimal combination protocol.MethodsA cerebral infarction rat model was established by transient middle cerebral artery occlusion (tMCAO). The Morris water maze test was conducted to assess the cognitive function of rats. RNA sequencing and bioinformatics analysis were employed to study the underlying mechanisms.ResultsrTMS, COG and rTMS-COG all had beneficial effects on PSCI, while cognitive training immediately after rTMS (rTMS-COG0h) achieved a better effect than cognitive training 1 h and 4 h after rTMS, rTMS and COG. We identified 179 differentially expressed genes (DEGs), including 24 upregulated and 155 downregulated genes, between the rTMS-COG0h and rTMS groups. GO analysis revealed that the major categories associated with the DEGs were antigen procession and presentation, regulation of protein phosphorylation and axoneme assembly. KEGG analysis showed that the DEGs were enriched in processes related to phagosome, circadian entrainment, dopaminergic synapse, apelin signaling pathway, long-term depression, neuroactive ligand-receptor interaction, axon guidance and glucagon signaling pathway. PPI analysis identified Calb2, Rsph1, Ccdc114, Acta2, Ttll9, Dnah1, Dlx2, Dlx1, Ccdc40 and Ccdc113 as related genes.ConclusionsThese findings prompt exploration of the potential mechanisms and key genes involved in the effect of rTMS-COG0h on PSCI.

简介：摘要中风的发病率高、死亡率高、致残率高，绝大多数病人有不同程度的难治性肌痉挛。严重影响患者的日常生活。如何有效治疗中风后肌痉挛，对改善病人的预后和生活质量，减少护理，提高康复水平具有极为重要的意义。经颅磁刺激（TMS）是近年来出现的无创性刺激大脑皮质的新技术，通过不同的强度、频率、频度、刺激部位、刺激模式使刺激部位的中枢神经产生长时程增强(LTP)或长时程抑制(LTD)效应，对神经功能产生双向调节的可塑性变化。因此我们推测经颅磁刺激技术刺激皮质和外周脊神经对皮质运动功能恢复重建、促进脊髓反射的调节功能可塑性改变对肌痉挛可能有较好的治疗作用。

简介：摘要：重复经颅磁刺激（rTMS）是一种非侵入性的大脑刺激技术，近年来在脑卒中后运动障碍的治疗中展现出极大的发展前景。本研究旨在梳理rTMS在治疗脑卒中后运动障碍的作用机理，深入分析rTMS的治疗参数、安全性、患者耐受度以及个性化治疗方案等特点，并对rTMS在下肢运动能力恢复、动作控制与协调提升等方面的具体应用进行了总结。最后展望了rTMS在新一代设备和技术改进以及与其他康复手段整合中的未来发展方向。

简介：摘要：重复经颅磁刺激（rTMS）是一种非侵入性的大脑刺激技术，近年来在脑卒中后运动障碍的治疗中展现出极大的发展前景。本研究旨在梳理rTMS在治疗脑卒中后运动障碍的作用机理，深入分析rTMS的治疗参数、安全性、患者耐受度以及个性化治疗方案等特点，并对rTMS在下肢运动能力恢复、动作控制与协调提升等方面的具体应用进行了总结。最后展望了rTMS在新一代设备和技术改进以及与其他康复手段整合中的未来发展方向。

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简介：摘要目的探讨重复经颅磁刺激(repetitive transcranial magnetic stimulation，rTMS)联合认知行为疗法(cognitive behavioral therapies，CBT)对酒依赖患者的饮酒渴求和认知功能的影响。方法2019年3月至2021年9月纳入酒依赖患者150例。对入组者进行计算机算法自动随机分配，分为rTMS治疗组(rTMS+假CBT，n＝41)、CBT治疗组(CBT+假rTMS，n＝34)、rTMS+CBT治疗组(n＝36)和对照组(假rTMS+假CBT，n＝39)。在基线期(治疗前，W0)与治疗2周(W2)、8周(W8)、12周(W12)、24周(W24)，分别采用饮酒问卷(alcohol dependence scale，ADS)评估患者酒精依赖程度；强制饮酒量表(obsessive compulsive drinking scale，OCDS)评估患者饮酒渴求程度；蒙特利尔认知评估量表(Montreal cognitive assessment，MoCA)评估患者认知功能。采用SPSS 23.0软件进行统计分析，使用重复测量方差分析及简单效应分析比较4组的ADS、OCDS、MoCA量表评分差异。结果(1)四组患者分别在W0、W12、W24进行ADS量表的评估，组别×时间的交互作用(F＝1.279，P＝0.279)和组别主效应不显著(F＝0.882，P＝0.454)，时间主效应显著(F＝12.925，P<0.001)；进一步简单效应分析，rTMS+CBT组在随访第24周时，ADS量表评分低于基线期[(14.48±5.70)分，(10.00±6.51)分](P＝0.01)。(2)四组受试者分别在W0、W2、W8、W12、W24进行OCDS量表的评估，组别×时间交互作用显著(F＝2.015，P＝0.042)；进一步简单效应分析，rTMS组、rTMS+CBT组在各随访时间节点，OCDS量表评分均低于基线期(均P<0.05)。(3)四组受试者分别在W0、W8、W12、W24进行MoCA量表的评估，组别×时间的交互作用不显著(F＝1.660，P＝0.106)，组别主效应及时间主效应均显著(F＝2.964，P＝0.038；F＝14.239，P<0.001)。进一步简单效应分析，CBT组在第24周时，MoCA量表评分高于基线期[(21.73±5.81)分，(24.60±3.98)分](P＝0.029)；rTMS+CBT组在第24周时，MoCA量表评分高于第8周时[(23.50±6.01)分，(25.95±2.87)分](P＝0.006)；在随访第12周时，rTMS组MoCA量表评分高于对照组[(22.08±6.64)分，(26.64±2.46)分](P＝0.009)。结论rTMS联合CBT治疗能改善酒依赖患者饮酒渴求及认知功能，且有较好的长期效果。

简介：摘要ObjectiveTo identify the effects of rTMS intervention on PSCI patients and its potential neural correlates to behavioral improvements.MethodsWe recruited 34 PSCI patients for 20 sessions of 10 Hz rTMS or no-stim control treatments over the left dorsal lateral prefrontal cortex (DLPFC). Cognitive function was evaluated with the Montreal Cognitive Assessment Scale, Victoria Stroop Test, Rivermead Behavior Memory Test, and Activities of Daily Living (ADL) assessed with the Modified Barthel Index. 14 patients received functional MRI scan, a useful non-invasive technique of determining how structurally segregated and functionally specialized brain areas were interconnected, which was reflected by blood oxygenation level-dependent signals. The amplitude of low-frequency fluctuation (ALFF) and functional connectivity (FC) were applied as the analytical approaches, which were used to measure the resting-state brain activity and functional connection.ResultsrTMS improved cognitive functions and ADLs for PSCI patients relative to patients who received no-stim control treatment. The cognitive improvements correlated to increased ALFF of the left medial prefrontal cortex, and increased FC of right medial prefrontal cortex and right ventral anterior cingulate cortex.Conclusions10 Hz rTMS at DLPFC could improve cognitive function and quality of life for PSCI patients, which is associated with an altered frontal cortical activity.

简介：摘要目的探讨重复经颅磁刺激(rTMS)联合帕罗西汀治疗焦虑症患者的应用效果。方法选取我院2017年2月—2018年2月期间收治的焦虑症患者72例为研究对象，随机分为两组，对照组为帕罗西汀，观察组为rTMS联合帕罗西汀，对比两组治疗情况。结果干预后，两组的PANSS评分低于干预前，观察组低于对照组，统计学有意义（P＜0.05）。结论rTMS联合帕罗西汀治疗焦虑症患者的应用效果显著，改善了症状，提高了治疗效果，值得应用。

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