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

摘要：

目的　探讨小脑中枢爆发式磁刺激（cTBS）联合外周低频重复磁刺激（rTMS）治疗脑卒中后上肢痉挛患者效果及其对ApoB和BDNF水平的影响。方法　采用回顾性分析，收集2023年6月至2024年3月期间在陕西省康复医院接受康复治疗的120例脑卒中后上肢痉挛患者临床资料，根据治疗方式不同分为３组。常规组40例，男25例、女15例，年龄（67.38±6.17）岁，病程（4.28±1.10）年，行常规康复训练；中枢组40例，男24例、女16例，年龄（66.94±6.25）岁，病程（4.54±1.21）年，在对照组的基础上接受双侧cTBS治疗；联合组40例，男26例、女14例，年龄（67.15±6.36）岁，病程（4.46±1.35）年，在中枢组的基础上增加外周上肢低频rTMS治疗。3组均治疗8周，1次/d，5次/周。通过临床痉挛量表（MAS）、上肢运动功能评定量表（FMA）、卒中特异生活质量量表（SS-QOL）及神经功能缺损评分（NHISS）评估治疗效果，同时监测治疗前后载脂蛋白B（ApoB）、脑源性神经营养因子（BDNF）水平及上肢表面肌电图均方根（RMS）值的变化。采用t、F和χ²检验进行统计学分析。结果　治疗后，联合组MAS评分为（1.35±0.54）分，低于常规组（2.52±0.78）分和中枢组（2.06±0.63）分；联合组FMA评分为（28.60±2.25）分，高于常规组（20.31±2.67）分和中枢组（23.08±2.86）分；联合组SS-QOL评分为（113.53±13.74）分，高于常规组（91.39±9.67）分、中枢组（100.82±10.21）分；联合组NIHSS评分为（8.32±1.49）分，低于常规组（10.42±2.86）分和中枢组（9.15±1.78）分。牵伸状态下，联合组肱二头肌RMS值为（13.35±3.21）μV/s，低于常规组（21.67±4.68）μV/s和中枢组（17.64±4.35）μV/s；联合组肱三头肌RMS值为（13.15±2.06）μV/s，低于常规组（21.35±3.59）μV/s和中枢组（16.79±3.27）μV/s。静息状态下，联合组肱二头肌RMS值为（10.25±1.66）μV/s，低于常规组（16.85±2.18）μV/s和中枢组（14.06±1.89）μV/s；联合组肱三头肌RMS值为（12.80±1.79）μV/s，低于常规组（17.14±2.32）μV/s和中枢组（15.48±1.95）μV/s。联合组ApoB为（0.86±0.15）g/L，低于常规组（1.42±0.37）g/L和中枢组（1.05±0.24）g/L；联合组BDNF为（20.65±3.08）μg/L，高于常规组（15.89±3.17）μg/L和中枢组（17.98±2.73）μg/L。上述指标3组比较，差异均有统计学意义（均P<0.05）。结论　cTBS联合外周低频rTMS能够有效改善脑卒中后上肢痉挛患者的痉挛程度和运动功能，同时显著降低ApoB水平，提升BDNF水平，疗效显著优于单一的中枢刺激或常规康复治疗。

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