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101.
《Brain stimulation》2019,12(6):1553-1555
BackgroundMultiple prior treatment failures are associated with reduced rates of remission to subsequent antidepressant treatment, including rTMS. The degree of treatment resistance that is especially predictive of inferior outcome is uncertain. Intermittent theta burst stimulation (iTBS) is a newer form of rTMS where less is known regarding clinical predictors of remission. The THREE-D study demonstrated that iTBS is non-inferior to 10 Hz rTMS for the treatment of depression.ObjectiveDetermine if the number and type of prior pharmacotherapy trials affect the rate of remission with two types of rTMS.MethodCompare remission rates based on prior pharmacotherapy using data from the THREE-D trial (NCT01887782).ResultsNo differences in remission rates were noted between the three levels of treatment resistance, however, participants with 3 compared to <3 treatment failures had lower rates of remission: 17.3% versus 29.4% (χ2 4.87; df = 1; p = 0.03).ConclusionsThree or more treatment failures may be associated with lower remission rates with rTMS. 相似文献
102.
Dennis R. Louie Shannon B. Lim Janice J. Eng 《Journal of stroke and cerebrovascular diseases》2019,28(1):107-120
Background
Mirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke.Methods
PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and PsychINFO were searched from inception to May 2018 for randomized controlled trials (RCTs) comparing lower extremity mirror therapy to a control intervention for people with stroke. Pooled effects were determined by separate meta-analyses of gait speed, mobility, balance, and motor recovery.Results
Seventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favoring mirror therapy in at least one lower extremity outcome. In a meta-analysis of 6 trials that reported change in gait speed, a large beneficial effect was observed following mirror therapy training (standardized mean differences [SMD]?=?1.04 [95% confidence interval [CI]?=?.43, 1.66], I2?=?73%, and P < .001). Lower extremity mirror therapy also had a positive effect on mobility (5 studies, SMD?=?.46 [95% CI?=?.01, .90], I2?=?43%, and P = .05) and motor recovery (7 studies, SMD?=?.47 [95% CI?=?.21, .74], I2?=?0%, and P < .001). A significant pooled effect was not found for balance capacity.Conclusions
Mirror therapy for the lower extremity has a large effect for gait speed improvement. This review also found a small positive effect of mirror therapy for mobility and lower extremity motor recovery after stroke. 相似文献103.
《Brain stimulation》2022,15(2):458-471
BackgroundTranscranial magnetic stimulation (TMS) is a non-invasive neuromodulation modality that can treat depression, obsessive-compulsive disorder, or help smoking cessation. Research suggests that timing the delivery of TMS relative to an endogenous brain state may affect efficacy and short-term brain dynamics.ObjectiveTo investigate whether, for a multi-week daily treatment of repetitive TMS (rTMS), there is an effect on brain dynamics that depends on the timing of the TMS relative to individuals’ prefrontal EEG quasi-alpha rhythm (between 6 and 13 Hz).MethodWe developed a novel closed-loop system that delivers personalized EEG-triggered rTMS to patients undergoing treatment for major depressive disorder. In a double blind study, patients received daily treatments of rTMS over a period of six weeks and were randomly assigned to either a synchronized or unsynchronized treatment group, where synchronization of rTMS was to their prefrontal EEG quasi-alpha rhythm.ResultsWhen rTMS is applied over the dorsal lateral prefrontal cortex (DLPFC) and synchronized to the patient's prefrontal quasi-alpha rhythm, patients develop strong phase entrainment over a period of weeks, both over the stimulation site as well as in a subset of areas distal to the stimulation site. In addition, at the end of the course of treatment, this group's entrainment phase shifts to be closer to the phase that optimally engages the distal target, namely the anterior cingulate cortex (ACC). These entrainment effects are not observed in the group that is given rTMS without initial EEG synchronization of each TMS train.ConclusionsThe entrainment effects build over the course of days/weeks, suggesting that these effects engage neuroplastic changes which may have clinical consequences in depression or other diseases. 相似文献
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106.
Pierre Nicolo Cécile Magnin Elena Pedrazzini Gijs Plomp Anaïs Mottaz Armin Schnider Adrian G. Guggisberg 《Archives of physical medicine and rehabilitation》2018,99(5):862-872.e1
Objective
To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke.Design
Double-blinded, randomized, placebo-controlled study.Setting
University hospital rehabilitation unit.Participants
Inpatients with stroke (N=41; mean age, 65y; range, 28–85y; mean weeks poststroke, 5; range, 2–10) with resultant paresis in the upper extremity (mean Fugl-Meyer score, 14; range, 3–48).Interventions
Subjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks, combined with physical therapy.Main Outcome Measures
Brain function was assessed with directed and nondirected functional connectivity based on high-density electroencephalography before and after stimulation sessions. Primary clinical end point was the change in slope of the multifaceted motor score composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score, 9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and the treatment time.Results
Neither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS induced different neural effects. Only cTBS was able to reduce transcallosal influences from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation analyses indicated that the modulation of interhemispheric driving and perilesional beta-band connectivity were not independent mediators for functional recovery across all patients. However, exploratory subgroup analyses suggest that the enhancement of perilesional beta-band connectivity through tDCS might have more robust clinical gains if started within the first 4 weeks after stroke.Conclusions
The inhibition of the contralesional M1 or the reduction of interhemispheric interactions was not clinically useful in the heterogeneous group of subjects with subacute stroke. An early modulation of perilesional oscillation coherence seems to be a more promising strategy for brain stimulation interventions. 相似文献107.
Yuval Bloch Shira Arad Yechiel Levkovitz 《The world journal of biological psychiatry》2016,17(7):557-561
Objectives. In a considerable minority of patients who suffer from Tourette syndrome (TS) the disorder persists into adulthood and is associated with severe symptoms and limited therapeutic options. Repetitive transcranial magnetic stimulation (rTMS) to the supplementary motor area (SMA) has shown promising therapeutic results. Deep rTMS is a novel technology that enables deeper non-invasive cortical stimulation. This open-label pilot study is the first to examine the possible role of deep rTMS as add-on treatment for intractable TS. Methods. Twelve patients were recruited in order to examine bilateral SMA inhibition via deep TMS using the HBDL coil, as a possible treatment for adult TS treatment-resistant patients. Two patients did not complete the 20-day study protocol. Results. There were no significant side effects. While tics did not improve among the group as a whole, the subgroup of six patients with combined TS and OCD (obsessive compulsive syndrome) showed significant improvement in tic severity (P = 0.037). Conclusions. These findings support the safety of deep rTMS for treating TS. The results also highlight the importance of studying the different TS syndromes separately (e.g., with or without OCD comorbidity) when evaluating deep rTMS protocols for TS patients. 相似文献
108.
目的:观察重复经颅磁刺激(rTMS)对遗忘型轻度认知功能障碍(aMCI)患者认知功能的影响及对脑网络的调控作用.方法:将30例aMCI患者随机分为rTMS组(真刺激组)15例和rTMS假刺激组(假刺激组)15例.进行蒙特利尔认知评估量表(MoCA)、临床记忆量表(CMS)测试,采集结构性磁共振成像(sMRI),同时真刺激组采集其静息态功能磁共震成像(fMRI)数据;磁刺激参数:刺激部位为左侧额叶背外侧皮质(dlPFC),强度为RMT的90%,频率为15 Hz,每日20个序列,间隔时间25 s,5d为1个疗程,连续治疗2个疗程.rTMS治疗结束后再次进行量表测试,采集真刺激组fMRI数据.比较两组治疗前后的MoCA、CMS测试结果;分析以左侧dlPFC为感兴趣区域(ROI)的功能性连接情况.结果:①rTMS对aMCI的认知能力有改善作用;②真刺激组治疗后右侧额中、左侧三角部额下回、双侧丘脑等多个脑区与左侧dlPFC功能性连接增强,右侧补充运动区等脑区连接降低.结论:高频rT-MS对aMCI患者的默认模式网络(DMN)有修复作用. 相似文献
109.
目的:探讨重复经颅磁刺激治疗广泛性焦虑障碍患者的疗效和安全性。方法将60例广泛性焦虑障碍患者随机分为两组,研究组予以重复经颅磁刺激,同时口服复合维生素片治疗,对照组口服丁螺环酮治疗,同时予以经颅磁假刺激,观察4周。于治疗前后采用汉密顿焦虑量表、焦虑自评量表、匹兹堡睡眠质量指数量表评定临床疗效,随时记录治疗过程中出现的不良反应。结果治疗各时点两组各量表评分均较治疗前显著下降(P<0.01),同期两组间评分比较差异均无显著性( P>0.05);治疗过程中两组均未出现严重不良反应。结论重复经颅磁刺激治疗广泛性焦虑障碍疗效显著,与丁螺环酮相当,治疗安全性高,依从性好。 相似文献
110.
目的:观察高频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)对脑卒中后认知障碍(poststroke cognitive impairment,PSCI)患者认知功能及日常生活活动能力(activities of daily living,ADL)的影响。方法:将25例PSCI患者随机分为刺激组(12例)和安慰刺激组(13例)。两组患者均予常规药物治疗及康复训练,刺激组在此基础上予左前额叶背外侧区10Hz rTMS治疗,安慰刺激组予假刺激,共治疗4周。治疗前、治疗2、4周后采用蒙特利尔认知评估量表、维多利亚版Stroop测试、Rivermead行为记忆测验评估患者认知功能,予改良Barthel指数量表评估患者ADL。结果:刺激组患者执行、记忆及整体认知功能在治疗2周及4周后均显著改善(P0.05),安慰刺激组患者上述功能在治疗4周后显著改善(P0.05),刺激组患者执行功能及总体认知功能提高的幅度显著高于安慰刺激组患者(P0.05)。两组患者ADL在治疗2周及4周后均显著提高(P0.05),刺激组患者提高的幅度显著高于安慰刺激组患者(P0.05)。结论:高频rTMS治疗可有效改善PSCI患者认知功能及ADL。 相似文献