Comparative Efficacy of Noninvasive Neurostimulation Therapies for Acute and Subacute Poststroke Dysphagia: A Systematic Review and Network Meta-analysis

Objective

To investigate the effectiveness of noninvasive neurostimulation therapies in patients with poststroke dysphagia.

rTMS对aMCI患者认知功能的影响及对脑网络的调控作用

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.     

重复经颅磁刺激治疗广泛性焦虑障碍对照研究

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。     

高频重复经颅磁刺激治疗脑卒中患者单侧空间忽略的功能磁共振研究

目的:观察高频重复经颅磁刺激(r TMS)治疗脑卒中患者单侧空间忽略(USN)的临床疗效并调查r TMS疗效的神经影像学机制。方法:30例脑卒中后USN患者随机分为试验组和对照组各15例,两组患者均进行常规康复治疗;试验组给予额外的r TMS治疗,治疗强度为运动阈值的95%,频率10Hz,刺激点位于患侧右顶叶皮质区域(EEG 10-20标准的P4点),每次治疗10min,2次/d,连续治疗10天。观察治疗前及治疗10天后行为学表现和静息态f MRI改变情况。结果:和对照组相比,r TMS治疗后试验组USN症状明显改善(线段划销实验,P=0.038);图形删除测试,P=0.034;凯瑟琳-波哥量表,P0.05);高频r TMS治疗可增强患侧脑区颞上回、额中回、顶上小叶、楔前叶及小脑前叶兴奋性,增强患侧半球的竞争抑制作用。结论:高频r TMS可明显改善脑卒中患者USN症状,并且可以使功能脑网络发生可塑性改变,平衡左右大脑半球兴奋性。     

Neuropharmacological basis of rTMS-induced analgesia: the role of endogenous opioids

We investigated the role of endogenous opioid systems in the analgesic effects induced by repetitive transcranial magnetic stimulation (rTMS). We compared the analgesic effects of motor cortex (M1) or dorsolateral prefrontal cortex (DLPFC) stimulation before and after naloxone or placebo treatment, in a randomized, double-blind crossover design, in healthy volunteers. Three groups of 12 volunteers were selected at random and given active stimulation (frequency 10 Hz, at 80% motor threshold intensity, 1500 pulses per session) of the right M1, active stimulation of the right DLPFC, or sham stimulation, during two experimental sessions 2 weeks apart. Cold pain thresholds and the intensity of pain induced by a series of fixed-temperature cold stimuli (5, 10, and 15 °C) were used to evaluate the analgesic effects of rTMS. Measurements were made at the left thenar eminence, before and 1 hour after the intravenous injection of naloxone (bolus of 0.1 mg/kg followed by a continuous infusion of 0.1 mg/kg/h until the end of rTMS) or placebo (saline). Naloxone injection significantly decreased the analgesic effects of M1 stimulation, but did not change the effects of rTMS of the DLPFC or sham rTMS. This study demonstrates, for the first time, the involvement of endogenous opioid systems in rTMS-induced analgesia. The differential effects of naloxone on M1 and DLPFC stimulation suggest that the analgesic effects induced by the stimulation of these 2 cortical sites are mediated by different mechanisms.     

高频重复经颅磁刺激对脑卒中后认知功能障碍的影响

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。     

Comparison of Neuroplastic Responses to Cathodal Transcranial Direct Current Stimulation and Continuous Theta Burst Stimulation in Subacute Stroke

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.

Deep TMS add-on treatment for intractable Tourette syndrome: A feasibility study

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.     

重复经颅磁刺激联合艾司西酞普兰治疗女性首发抑郁症的早期疗效观察

目的:探讨重复经颅磁刺激(rTMS)联合艾司西酞普兰治疗女性首发抑郁症的早期疗效和安全性。方法:将50例抑郁症患者随机分为rTMS联合艾司西酞普兰组(研究组,n=25例)和单用艾司西酞普兰治疗组(对照组,n=25例)。采用汉密尔顿抑郁量表(HAMD)和抑郁自评量表(SDS)在治疗前和治疗第1、2、4、8周分别对两组患者评定疗效;治疗中用副反应量表(TESS)评定不良反应。结果:治疗前和第8周两组患者HAMD评分的差异无统计学意义(P均>0.05);治疗第1、2、4周末,研究组患者HAMD评分明显低于对照组,差异有统计学意义(P均<0.05),且治疗第4周末时,研究组显著优于对照组,差异有统计学意义(P<0.01)。两组间患者不良反应发生率差异无统计学意义(P>0.05)。结论:rTMS联合艾司西酞普兰治疗女性首发抑郁症早期疗效和安全性均优于单一用药。