Stroke Clinical Trial
Official title:
Effects of Different Frequency rTMS on Brain Functional and Structural Alterations in Stroke Patient: Multi-modal MRI Study
In this study, the investigators aim to evaluate functional and structural improvements in
the brain of stroke patients after rTMS treatment using multi-modal MRI techniques.
Specifically, the investigators sought to determine whether rTMS treatment modulate the brain
function and structure in patients and, if so, whether different frequency of the rTMS
treatment will affect the degree of the motor recovery in patients' brain.
The patients will be randomized into three groups: Experimental group 1 (TMS group) received
low frequency rTMS; Experimental group 2 (TMS group) received high frequency rTMS; The third
group who received only physical therapy constituted the control group. All patients undergo
MRI scan one day before and after rTMS treatment.
As the second leading cause of death and major cause of disability in the world, stroke is
the rapid loss of brain function due to disturbance in the blood supply to the brain.
Approximately two thirds of patients with stroke have impaired motor function even at three
to six months after stroke onset. The abnormally increased interhemispheric inhibition driven
from the unaffected to the affected hemisphere is associated with the motor impairment, which
is characterized by increased cortical excitability in the unaffected hemisphere and
decreased cortical excitability in the affected hemisphere. Rebalancing the cortical
excitability between two hemispheres is associated with a better overall prognosis.
Repetitive transcranial magnetic stimulation (rTMS) is a painless, noninvasive brain
stimulation technique. High-frequency rTMS facilitates cortical excitability, whereas
low-frequency rTMS decreases the cortical excitability of the stimulated hemisphere.
Therefore, rTMS can be used to increase and decrease the cortical excitability of the
affected and unaffected hemispheres, respectively, and may facilitate motor function after
stroke. However, the previous studies commonly applied behavioral scales to evaluate the
effect of the rTMS treatment, little is known how the brain function and structure recover
after rTMS treatment and whether the different frequency of rTMS will affect the recovery in
the brain of stroke patients.
Non-invasive neuroimaging techniques provide promising avenues to detect brain function and
structure in patients after stroke onset and have been increasingly applied to this disease.
The morphology of the brain (cortical thickness, gray matter volume) is commonly assessed
using T1-weighted MRI (Structural MRI). Diffusion tensor imaging (DTI) is a promising
technique to study human brain structure, especially white matter anatomy, by providing
multiple quantitative parameters to characterize tissue microstructure from different
aspects. Functional magnetic resonance imaging (fMRI) is a functional neuroimaging technique
which measures the changes of the blood oxygenation level-dependent (BOLD) signal that are
highly correlated with neural activities. Task fMRI which applies stimulus-response pattern
to identify the regions activated by performance of a cognitive task, while resting-state
fMRI (rs-fMRI) is a promising tool to map intrinsic function of the human brain, which has
unique advantages in clinical conditions because it does not require participants to engage
in cognitive activities.
In this study, the investigators aim to evaluate functional and structural improvements in
the brain of stroke patients after rTMS treatment using multi-modal MRI techniques.
Specifically, the investigators sought to determine whether rTMS treatment modulate the brain
function and structure in stroke patients and, if so, whether different frequency of the rTMS
treatment will affect the degree of the motor recovery in patients' brain.
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