Cargando…
Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments
BACKGROUND: Previous studies have revealed that low frequency repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (cM1) is less effective in severe stroke patients with poor neural structural reserve than in patients with highly reserved descending motor path...
Autores principales: | , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8973524/ https://www.ncbi.nlm.nih.gov/pubmed/35365121 http://dx.doi.org/10.1186/s12883-022-02629-x |
_version_ | 1784680056526733312 |
---|---|
author | Li, Jiali Wang, Hewei Yuan, Yujian Fan, Yunhui Liu, Fan Zhu, Jingjing Xu, Qing Chen, Lan Guo, Miao Ji, Zhaoying Chen, Yun Yu, Qiurong Gao, Tianhao Hua, Yan Fan, Mingxia Sun, Limin |
author_facet | Li, Jiali Wang, Hewei Yuan, Yujian Fan, Yunhui Liu, Fan Zhu, Jingjing Xu, Qing Chen, Lan Guo, Miao Ji, Zhaoying Chen, Yun Yu, Qiurong Gao, Tianhao Hua, Yan Fan, Mingxia Sun, Limin |
author_sort | Li, Jiali |
collection | PubMed |
description | BACKGROUND: Previous studies have revealed that low frequency repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (cM1) is less effective in severe stroke patients with poor neural structural reserve than in patients with highly reserved descending motor pathway. This may be attributed to the fact that secondary motor cortex, especially contralesional dorsal premotor cortex (cPMd), might play an important compensatory role in the motor function recovery of severely affected upper extremity. The main purpose of this study is to compare the effectiveness of low frequency rTMS on cM1 and high frequency rTMS on cPMd in subcortical chronic stroke patients with severe hemiplegia. By longitudinal analysis of multimodal neuroimaging data, we hope to elucidate the possible mechanism of brain reorganization following different treatment regimens of rTMS therapy, and to determine the cut-off of stimulation strategy selection based on the degree of neural structural reserve. METHODS/DESIGN: The study will be a single-blinded randomized controlled trial involving a total of 60 subcortical chronic stroke patients with severe upper limb motor impairments. All patients will receive 3 weeks of conventional rehabilitation treatment, while they will be divided into three groups and receive different rTMS treatments: cM1 low frequency rTMS (n = 20), cPMd high frequency rTMS (n = 20), and sham stimulation group (n = 20). Clinical functional assessment, multimodal functional MRI (fMRI) scanning, and electrophysiological measurement will be performed before intervention, 3 weeks after intervention, and 4 weeks after the treatment, respectively. DISCUSSION: This will be the first study to compare the effects of low-frequency rTMS of cM1 and high-frequency rTMS of cPMd. The outcome of this study will provide a theoretical basis for clarifying the bimodal balance-recovery model of stroke, and provide a strategy for individualized rTMS treatment for stroke in future studies and clinical practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900027399. Registered on 12 Nov 2019, http://www.chictr.org.cn/showproj.aspx?proj=43686. |
format | Online Article Text |
id | pubmed-8973524 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-89735242022-04-02 Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments Li, Jiali Wang, Hewei Yuan, Yujian Fan, Yunhui Liu, Fan Zhu, Jingjing Xu, Qing Chen, Lan Guo, Miao Ji, Zhaoying Chen, Yun Yu, Qiurong Gao, Tianhao Hua, Yan Fan, Mingxia Sun, Limin BMC Neurol Study Protocol BACKGROUND: Previous studies have revealed that low frequency repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (cM1) is less effective in severe stroke patients with poor neural structural reserve than in patients with highly reserved descending motor pathway. This may be attributed to the fact that secondary motor cortex, especially contralesional dorsal premotor cortex (cPMd), might play an important compensatory role in the motor function recovery of severely affected upper extremity. The main purpose of this study is to compare the effectiveness of low frequency rTMS on cM1 and high frequency rTMS on cPMd in subcortical chronic stroke patients with severe hemiplegia. By longitudinal analysis of multimodal neuroimaging data, we hope to elucidate the possible mechanism of brain reorganization following different treatment regimens of rTMS therapy, and to determine the cut-off of stimulation strategy selection based on the degree of neural structural reserve. METHODS/DESIGN: The study will be a single-blinded randomized controlled trial involving a total of 60 subcortical chronic stroke patients with severe upper limb motor impairments. All patients will receive 3 weeks of conventional rehabilitation treatment, while they will be divided into three groups and receive different rTMS treatments: cM1 low frequency rTMS (n = 20), cPMd high frequency rTMS (n = 20), and sham stimulation group (n = 20). Clinical functional assessment, multimodal functional MRI (fMRI) scanning, and electrophysiological measurement will be performed before intervention, 3 weeks after intervention, and 4 weeks after the treatment, respectively. DISCUSSION: This will be the first study to compare the effects of low-frequency rTMS of cM1 and high-frequency rTMS of cPMd. The outcome of this study will provide a theoretical basis for clarifying the bimodal balance-recovery model of stroke, and provide a strategy for individualized rTMS treatment for stroke in future studies and clinical practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900027399. Registered on 12 Nov 2019, http://www.chictr.org.cn/showproj.aspx?proj=43686. BioMed Central 2022-04-01 /pmc/articles/PMC8973524/ /pubmed/35365121 http://dx.doi.org/10.1186/s12883-022-02629-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Study Protocol Li, Jiali Wang, Hewei Yuan, Yujian Fan, Yunhui Liu, Fan Zhu, Jingjing Xu, Qing Chen, Lan Guo, Miao Ji, Zhaoying Chen, Yun Yu, Qiurong Gao, Tianhao Hua, Yan Fan, Mingxia Sun, Limin Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments |
title | Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments |
title_full | Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments |
title_fullStr | Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments |
title_full_unstemmed | Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments |
title_short | Effects of high frequency rTMS of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments |
title_sort | effects of high frequency rtms of contralesional dorsal premotor cortex in severe subcortical chronic stroke: protocol of a randomized controlled trial with multimodal neuroimaging assessments |
topic | Study Protocol |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8973524/ https://www.ncbi.nlm.nih.gov/pubmed/35365121 http://dx.doi.org/10.1186/s12883-022-02629-x |
work_keys_str_mv | AT lijiali effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT wanghewei effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT yuanyujian effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT fanyunhui effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT liufan effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT zhujingjing effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT xuqing effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT chenlan effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT guomiao effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT jizhaoying effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT chenyun effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT yuqiurong effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT gaotianhao effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT huayan effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT fanmingxia effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments AT sunlimin effectsofhighfrequencyrtmsofcontralesionaldorsalpremotorcortexinseveresubcorticalchronicstrokeprotocolofarandomizedcontrolledtrialwithmultimodalneuroimagingassessments |