关键词: 脑卒中, 小脑中枢爆发式磁刺激, 外周低频重复磁刺激, 上肢痉挛

Abstract:

Objective　To investigate the effect of cerebellar continuous theta burst stimulation (cTBS) combined with peripheral low-frequency repetitive transcranial magnetic stimulation (rTMS) for patients with post-stroke upper limb spasticity and its impact on ApoB and BDNF levels. Methods　One hundred and twenty patients with post-stroke upper limb spasticity who underwent rehabilitation treatment at Shaanxi Rehabilitation Hospital between June 2023 and March 2024 were selected as the study objects. The patients were divided into three groups according to the treatment methods, with 40 cases in each group. There were 25 males and 15 females in the conventional group; they were (67.38±6.17) years old; their disease course was (4.28±1.10) years. There were 24 males and 16 females in the central stimulation group; they were (66.94±6.25) years old; their disease course was (4.54±1.21) years. There were 26 males and 14 females in the combined group; they were (67.15±6.36) years old; their disease course was (4.46±1.35) years. The conventional group took conventional rehabilitation training. The central stimulation group took bilateral cTBS and conventional rehabilitation training. The combined group took peripheral upper limb low-frequency rTMS, bilateral cTBS, and conventional rehabilitation training. All the three groups underwent treatment once per day, five times per week, for 8 weeks. The treatment effects were evaluated by the Modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA), Stroke-Specific Quality of Life Scale (SS-QOL), and National Institutes of Health Stroke Scale (NIHSS). The levels of apolipoprotein B (ApoB) and brain-derived neurotrophic factor (BDNF) and root mean squares (RMS) of upper limb surface electromyography (sEMG) were measured before and after the treatment. t, F, and χ² tests were used for the statistical analysis. Results　After the treatment, the scores of MAS, FMA, SS-QOL, and NIHSS in the combined group were 1.35±0.54, 28.60±2.25, 113.53±13.74, and 8.32±1.49; the scores in the conventional group were 2.52±0.78, 20.31±2.67, 91.39±9.67, and 10.42±2.86; the scores in the central stimulation group were 2.06±0.63, 23.08±2.86, 100.82±10.21, and 9.15±1.78. Under stretching conditions, the RMS's of the biceps brachii and triceps brachii in the combined group, the conventional group, and the central stimulation group were (13.35±3.21) μV/s and (13.15±2.06) μV/s, (21.67±4.68) μV/s and (21.35±3.59) μV/s, and (17.64±4.35) μV/s and (16.79±3.27) μV/s. Under resting conditions, the RMS's of the biceps brachii and triceps brachii in the combined group, the conventional group, and the central stimulation group were (10.25±1.66) μV/s and (12.80±1.79) μV/s, (16.85±2.18) μV/s and (17.14±2.32) μV/s, and (14.06±1.89) μV/s and (15.48±1.95) μV/s. The levels of ApoB and BDNF in the combined group, the conventional group, and the central stimulation group were (0.86±0.15) g/L and (20.65±3.08) μg/L, (1.42±0.37) g/L and (15.89±3.17) μg/L, and (1.05±0.24) g/L and (17.98±2.73) μg/L. There were statistical differences (all P<0.05). Conclusion　cTBS combined with peripheral low-frequency rTMS for patients with post-stroke upper limb spasticity can effectively improve their spasticity, motor function, levels of ApoB and BDNF, demonstrating superior efficacy compared to single central stimulation or conventional rehabilitation therapy.

Key words: Stroke,  , Cerebellar continuous theta burst stimulation,  , Peripheral low-frequency repetitive transcranial magnetic stimulation,  , Upper limb spasticity