Transcranial magnetic stimulation,a type of noninvasive brain stimulation,has become an ancillary therapy for motor function rehabilitation.Most previous studies have focused on the effects of repetitive transcranial ...Transcranial magnetic stimulation,a type of noninvasive brain stimulation,has become an ancillary therapy for motor function rehabilitation.Most previous studies have focused on the effects of repetitive transcranial magnetic stimulation(rTMS)on motor function in stroke patients.There have been relatively few studies on the effects of different modalities of rTMS on lower extremity motor function and corticospinal excitability in patients with stroke.The MEDLINE,Embase,Cochrane Library,ISI Science Citation Index,Physiotherapy Evidence Database,China National Knowledge Infrastructure Library,and ClinicalTrials.gov databases were searched.Parallel or crossover randomized controlled trials that addressed the effectiveness of rTMS in patients with stroke,published from inception to November 28,2019,were included.Standard pairwise meta-analysis was conducted using R version 3.6.1 with the“meta”package.Bayesian network analysis using the Markov chain Monte Carlo algorithm was conducted to investigate the effectiveness of different rTMS protocol interventions.Network meta-analysis results of 18 randomized controlled trials regarding lower extremity motor function recovery revealed that low-frequency rTMS had better efficacy in promoting lower extremity motor function recovery than sham stimulation.Network meta-analysis results of five randomized controlled trials demonstrated that highfrequency rTMS led to higher amplitudes of motor evoked potentials than low-frequency rTMS or sham stimulation.These findings suggest that rTMS can improve motor function in patients with stroke,and that low-frequency rTMS mainly affects motor function,whereas high-frequency rTMS increases the amplitudes of motor evoked potentials.More highquality randomized controlled trials are needed to validate this conclusion.The work was registered in PROSPERO(registration No.CRD42020147055)on April 28,2020.展开更多
Objective:To examine the effect of anterior cruciate ligament(ACL)reconstruction on spinal-reflex and corticospinal excitability of the quadriceps muscle.Methods:A comprehensive electronic database search was performe...Objective:To examine the effect of anterior cruciate ligament(ACL)reconstruction on spinal-reflex and corticospinal excitability of the quadriceps muscle.Methods:A comprehensive electronic database search was performed to identify studies that objectively measured Hoffmann reflex to muscle response ratio,motor threshold,and motor evoked potentials after ACL reconstruction.Pooled standardized mean differences(SMDs)were computed using a random effects meta-analysis model.Results:A total of 13 studies were eligible for analysis.The Hoffmann reflex to muscle response ratio was significantly higher on both the reconstructed and non-reconstructed legs when compared with the healthy control leg(SMD=0.28,95%confidence interval(95%CI):0.08-0.49,p=0.006 and SMD=0.22,95%CI:0.04-0.40,p=0.016,respectively)but did not differ between legs(SMD=0.10,95%CI:-0.01 to 0.21,p=0.078).The motor threshold was significantly higher on both the reconstructed(SMD=0.76,95%CI:0.40-1.12,p<0.001)and non-reconstructed legs(SMD=0.47,95%CI:0.00-0.95,p=0.049)when compared with the legs of healthy controls.The reconstructed leg also had a higher motor threshold when compared with the non-reconstructed leg(SMD=0.20,95%CI:0.06-0.34,p=0.005).These changes were paralleled by bilateral reductions in quadriceps strength(ACL reconstructed:SMD=-0.78,95%CI:-1.07 to-0.49,p<0.001;non-reconstructed:SMD=-0.32,95%CI:-0.63 to-0.01,p=0.042)and quadriceps voluntary activation(ACL reconstructed:SMD=-0.73,95%CI:-0.97 to-0.50,p<0.001;non-reconstructed:SMD=-0.55,95%CI:-0.82 to-0.27,p<0.001)when compared with healthy controls.Conclusion:There is increased excitability of the spinal-reflex pathways and reduced excitability of the corticospinal pathways following ACL reconstruction.These changes are paralleled by reductions in quadriceps strength and voluntary activation,suggesting that rehabilitation interventions should focus on normalizing the excitability of neural pathways to effectively address quadriceps dysfunction after ACL reconstruction.展开更多
Background:Multiple prenatal and postnatal etiologies in cerebral palsy(CP)patients cause neural tissue damage and alterations in cortical neuronal activity and plasticity,leading to motor and cognitive deficits early...Background:Multiple prenatal and postnatal etiologies in cerebral palsy(CP)patients cause neural tissue damage and alterations in cortical neuronal activity and plasticity,leading to motor and cognitive deficits early in life.Repetitive transcranial magnetic stimulation(rTMS)to the lesioned or contralesional hemisphere has been shown to alleviate these functional deficits.However,the underlying mechanisms of the beneficial effects of rTMS via realigning intracortical and interhemispheric circuitry and excitability remain unclear.The present study explored the ability of primed low-frequency rTMS to modulate intracortical excitatory-inhibitory circuitry,interhemispheric and corticospinal integrity,and plasticity in infantile hemiplegic CP.Methods:The current study was a randomized,placebo-controlled trial with infantile hemiplegic CP patients.The active group received 6 Hz primed low-frequency 1Hz rTMS delivered to the contralesional primary motor cortex for 4 weeks,in 10 sessions.The placebo group received sham stimulation.Both groups also underwent 10 sessions of modified-constraint induced movement therapy(mCIMT).Pre-and post-intervention assessments were conducted using the Quality of Upper Extremity Skills Test to evaluate sensory and motor function,and the Modified Ashworth Scale(MAS)to assess spasticity.Additionally,cortical excitability and plasticity were measured using single-and paired-pulse TMS.Results:We found a significant increase in Quality of Upper Extremity Skills Test scores,CP Quality of Life Child(CP QOL-Child)scores,and grip strength,and a decrease in MAS scores in the active rTMS group compared with the sham group.Single-and paired-pulse paradigms revealed a significant decrease in resting and active motor threshold,a reduction in the cortical silent period,and short-and long-interval intracortical inhibition in the intervention group compared with the sham group.Conclusion:Primed low-frequency rTMS in the contralesional hemisphere combined with mCIMT shows potential for modulating motor neuronal excitability,rebalancing intracortical excitatory-inhibitory circuitry,and enhancing functional outcomes in children with infantile hemiparetic CP.展开更多
基金supported by the 1·3·5 project for disciplines of excellence-Clinical Research Incubation Project,West China Hospital,Sichuan University,China,No.2020HXFH051(to QG).
文摘Transcranial magnetic stimulation,a type of noninvasive brain stimulation,has become an ancillary therapy for motor function rehabilitation.Most previous studies have focused on the effects of repetitive transcranial magnetic stimulation(rTMS)on motor function in stroke patients.There have been relatively few studies on the effects of different modalities of rTMS on lower extremity motor function and corticospinal excitability in patients with stroke.The MEDLINE,Embase,Cochrane Library,ISI Science Citation Index,Physiotherapy Evidence Database,China National Knowledge Infrastructure Library,and ClinicalTrials.gov databases were searched.Parallel or crossover randomized controlled trials that addressed the effectiveness of rTMS in patients with stroke,published from inception to November 28,2019,were included.Standard pairwise meta-analysis was conducted using R version 3.6.1 with the“meta”package.Bayesian network analysis using the Markov chain Monte Carlo algorithm was conducted to investigate the effectiveness of different rTMS protocol interventions.Network meta-analysis results of 18 randomized controlled trials regarding lower extremity motor function recovery revealed that low-frequency rTMS had better efficacy in promoting lower extremity motor function recovery than sham stimulation.Network meta-analysis results of five randomized controlled trials demonstrated that highfrequency rTMS led to higher amplitudes of motor evoked potentials than low-frequency rTMS or sham stimulation.These findings suggest that rTMS can improve motor function in patients with stroke,and that low-frequency rTMS mainly affects motor function,whereas high-frequency rTMS increases the amplitudes of motor evoked potentials.More highquality randomized controlled trials are needed to validate this conclusion.The work was registered in PROSPERO(registration No.CRD42020147055)on April 28,2020.
基金the National Institutes of Health(Grant No.R21-HD092614).
文摘Objective:To examine the effect of anterior cruciate ligament(ACL)reconstruction on spinal-reflex and corticospinal excitability of the quadriceps muscle.Methods:A comprehensive electronic database search was performed to identify studies that objectively measured Hoffmann reflex to muscle response ratio,motor threshold,and motor evoked potentials after ACL reconstruction.Pooled standardized mean differences(SMDs)were computed using a random effects meta-analysis model.Results:A total of 13 studies were eligible for analysis.The Hoffmann reflex to muscle response ratio was significantly higher on both the reconstructed and non-reconstructed legs when compared with the healthy control leg(SMD=0.28,95%confidence interval(95%CI):0.08-0.49,p=0.006 and SMD=0.22,95%CI:0.04-0.40,p=0.016,respectively)but did not differ between legs(SMD=0.10,95%CI:-0.01 to 0.21,p=0.078).The motor threshold was significantly higher on both the reconstructed(SMD=0.76,95%CI:0.40-1.12,p<0.001)and non-reconstructed legs(SMD=0.47,95%CI:0.00-0.95,p=0.049)when compared with the legs of healthy controls.The reconstructed leg also had a higher motor threshold when compared with the non-reconstructed leg(SMD=0.20,95%CI:0.06-0.34,p=0.005).These changes were paralleled by bilateral reductions in quadriceps strength(ACL reconstructed:SMD=-0.78,95%CI:-1.07 to-0.49,p<0.001;non-reconstructed:SMD=-0.32,95%CI:-0.63 to-0.01,p=0.042)and quadriceps voluntary activation(ACL reconstructed:SMD=-0.73,95%CI:-0.97 to-0.50,p<0.001;non-reconstructed:SMD=-0.55,95%CI:-0.82 to-0.27,p<0.001)when compared with healthy controls.Conclusion:There is increased excitability of the spinal-reflex pathways and reduced excitability of the corticospinal pathways following ACL reconstruction.These changes are paralleled by reductions in quadriceps strength and voluntary activation,suggesting that rehabilitation interventions should focus on normalizing the excitability of neural pathways to effectively address quadriceps dysfunction after ACL reconstruction.
基金the Indian Council of Medical Research(ICMR Delhi),grant file number ICMR 5/7/1659/CH/Adhoc/2019-RBMCH,and NO APCwas funded by the Indian Council Of Medical Research(ICMR Delhi).
文摘Background:Multiple prenatal and postnatal etiologies in cerebral palsy(CP)patients cause neural tissue damage and alterations in cortical neuronal activity and plasticity,leading to motor and cognitive deficits early in life.Repetitive transcranial magnetic stimulation(rTMS)to the lesioned or contralesional hemisphere has been shown to alleviate these functional deficits.However,the underlying mechanisms of the beneficial effects of rTMS via realigning intracortical and interhemispheric circuitry and excitability remain unclear.The present study explored the ability of primed low-frequency rTMS to modulate intracortical excitatory-inhibitory circuitry,interhemispheric and corticospinal integrity,and plasticity in infantile hemiplegic CP.Methods:The current study was a randomized,placebo-controlled trial with infantile hemiplegic CP patients.The active group received 6 Hz primed low-frequency 1Hz rTMS delivered to the contralesional primary motor cortex for 4 weeks,in 10 sessions.The placebo group received sham stimulation.Both groups also underwent 10 sessions of modified-constraint induced movement therapy(mCIMT).Pre-and post-intervention assessments were conducted using the Quality of Upper Extremity Skills Test to evaluate sensory and motor function,and the Modified Ashworth Scale(MAS)to assess spasticity.Additionally,cortical excitability and plasticity were measured using single-and paired-pulse TMS.Results:We found a significant increase in Quality of Upper Extremity Skills Test scores,CP Quality of Life Child(CP QOL-Child)scores,and grip strength,and a decrease in MAS scores in the active rTMS group compared with the sham group.Single-and paired-pulse paradigms revealed a significant decrease in resting and active motor threshold,a reduction in the cortical silent period,and short-and long-interval intracortical inhibition in the intervention group compared with the sham group.Conclusion:Primed low-frequency rTMS in the contralesional hemisphere combined with mCIMT shows potential for modulating motor neuronal excitability,rebalancing intracortical excitatory-inhibitory circuitry,and enhancing functional outcomes in children with infantile hemiparetic CP.
