Efficacy of repetitive transcranial magnetic stimulation combined with peripheral magnetic stimulation on movement symptom and exploration of the optimal population in Parkinson's disease: A randomized controlled trial

BACKGROUND

This study explores the efficacy of repetitive transcranial magnetic stimulation (rTMS) and rTMS combined with repetitive peripheral magnetic stimulation (rPMS) (hereinafter referred to as rTMS + rPMS) on motor symptoms and quality of life in Parkinson's disease (PD), and explores whether there are differences between the two treatment methods; At the same time, analyze data from different subgroups to explore the influencing factors, in order to find the most suitable treatment group.

METHODS

Eighty patients with PD were randomly divided into rTMS and rTMS + rPMS groups and administered 10 Hz rTMS, and 10 Hz rTMS + 25 Hz rPMS, respectively, for 10 days. Before and after treatment, the PD Motor Function Rating Scale (UPDRS Part III, 10m Walk Timing Test, Stand Up Walk Test Evaluation Scale (TUG)) and PD Quality of Life Questionnaire (PDQ-39) were used to evaluate the motor symptoms and quality of life. After quantifying the treatment effect, a comparative analysis of the efficacy before and after treatment was conducted. Simultaneously, we divided the two treatment groups into different subgroups, compared the subgroups under the same treatment method, analyzed the relevant factors affecting the treatment method, and found the most suitable treatment group.

RESULTS

(1) After rTMS or rTMS + rPMS, all scoring scales improved compared to those before treatment (P < .05). Compared to rTMS, rTMS + rPMS resulted in greater improvements in overall motor function (UPDRS III) and quality of life (PDQ-39) (P < .05). (2) Patients with rigidity-based type as the main type may be the most suitable for these two treatment methods (P < .05).(3) There was no significant difference in treatment efficiency between the two treatment methods for patients with PD at different disease stages, sexes, or treatment ages(P > .05).

CONCLUSION

Both rTMS and rTMS + rPMS can improve movement symptoms and quality of life in patients with PD. rTMS + rPMS was more beneficial for improving the overall motor function. Patients with rigidity-based type as the main type may be the most suitable for these two treatment methods. The therapies work in all age groups, all gender and irrespective of the disease stage with varying levodopa equivalent daily doses as well.

Functional Repetitive Neuromuscular Magnetic Stimulation (frNMS) Targeting the Tibialis Anterior Muscle in Children with Upper Motor Neuron Syndrome: A Feasibility Study

Non-invasive neurostimulation as an adjunctive intervention to task-specific motor training is an approach to foster motor performance in patients affected by upper motor neuron syndrome (UMNS). Here, we present first-line data of repetitive neuromuscular magnetic stimulation (rNMS) in combination with personalized task-specific physical exercises targeting the tibialis anterior muscle to improve ankle dorsiflexion (functional rNMS (frNMS)). The main objective of this pilot study was to assess the feasibility in terms of adherence to frNMS, safety and practicability of frNMS, and satisfaction with frNMS. First, during 10 training sessions, only physical exercises were performed (study period (SP) A). After a 1 week break, frNMS was delivered during 10 sessions (SPC). Twelve children affected by UMNS (mean age 8.9 ± 1.6 years) adhered to 93% (SPA) and 94% (SPC) of the sessions, and omittance was not related to the intervention itself in any case. frNMS was safe (no AEs reported in 88% of sessions, no AE-related discontinuation). The practicability of and satisfaction with frNMS were high. Patient/caregiver-reported outcomes revealed meaningful benefits on the individual level. The strength of the ankle dorsiflexors (MRC score) clinically meaningfully increased in four participants as spasticity of ankle plantar flexors (Tardieu scores) decreased in four participants after SPC. frNMS was experienced as a feasible intervention for children affected by UMNS. Together with the beneficial effects achieved on the individual level in some participants, this first study supports further real-world, large-scale, sham-controlled investigations to investigate the specific effects and distinct mechanisms of action of frNMS.

Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective

Stroke is a central nervous system disease that causes structural lesions and functional impairments of the brain, resulting in varying types, and degrees of dysfunction. The bimodal balance-recovery model (interhemispheric competition model and vicariation model) has been proposed as the mechanism of functional recovery after a stroke. We analyzed how combinations of motor observation treatment approaches, transcranial electrical (TES) or magnetic (TMS) stimulation and peripheral electrical (PES) or magnetic (PMS) stimulation techniques can be taken as accessorial physical therapy methods on symptom reduction of stroke patients. We suggest that top-down and bottom-up stimulation techniques combined with action observation treatment synergistically might develop into valuable physical therapy strategies in neurorehabilitation after stroke. We explored how TES or TMS intervention over the contralesional hemisphere or the lesioned hemisphere combined with PES or PMS of the paretic limbs during motor observation followed by action execution have super-additive effects to potentiate the effect of conventional treatment in stroke patients. The proposed paradigm could be an innovative and adjunctive approach to potentiate the effect of conventional rehabilitation treatment, especially for those patients with severe motor deficits.

Effects of repetitive peripheral magnetic stimulation on spasticity evaluated with modified Ashworth scale/Ashworth scale in patients with spastic paralysis: A systematic review and meta-analysis

BACKGROUND

Spasticity is a common motor disorder resulting from upper motor neuron lesions. It has a serious influence on an individual's motor function and daily activity. Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive and painless approach developed for therapeutic intervention in clinical rehabilitation. However, the effectiveness of this intervention on spasticity in patients with spastic paralysis remains uncertain.

OBJECTIVE

This study aimed to investigate the effectiveness of rPMS on spasticity, motor function, and activities of daily living in individuals with spastic paralysis.

METHODS

PubMed, PEDro, Embase, Cochrane Library, and Web of Science were searched for eligible papers with date up to March 31, 2022. Two independent researchers conducted study screening, data extraction, and methodological quality assessment. RCTs that explored the effects of rPMS on spasticity, motor function, and activities of daily living in patients with spastic paralysis were included for review. The Cochrane collaboration tool was used to assess methodological quality. The cumulative effects of available data were processed for a meta-analysis using Reedman software.

RESULTS

Eight studies with 297 participants were included. Most of the studies presented low to moderate risk of bias. Compared with the control group, the results showed that rPMS had a significant effect on spasticity (all spasticity outcomes: standardized mean difference [SMD] = -0.55, 95% confidence interval [CI]: -0.94 to -0.16, I 2 = 40%, and P = 0.006, Modified Ashworth Scale: mean difference [MD] = -0.48, 95% CI: -0.82 to -0.14, I 2 = 0%, and P = 0.006), motor function (Fugl-Meyer Assessment: MD = 4.17, 95% CI: 0.89 to 7.46, I 2 = 28%, and P = 0.01), and activities of daily living (Barthel Index: MD = 5.12, 95% CI: 2.58 to 7.67, I 2 = 0%, and P < 0.0001). No side effect was reported.

CONCLUSION

The meta-analysis demonstrated that the evidence supported rPMS in improving spasticity especially for passive muscle properties evaluated with Modified Ashworth Scale/Ashworth Scale, as well as motor function and daily activity of living in individuals with spastic paralysis.

STUDY REGISTRATION

The reviewed protocol of this study is registered in the international prospective register of systematic reviews (PROSPERO) (CRD42022322395).

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022322395.

Temporal effects of two interferential current applications on peripheral circulation in children with hemiplegic cerebral palsy

Objectives

To determine the short-term effects of sympathetic and peripheral stimulation of interferential current (IFC) on blood flow (BF) in children with hemiplegic cerebral palsy (CP).

Methods

Thirty children with hemiplegic CP, ranging from 8 to 12 years old, were randomly divided into three groups (10 children/group). The first group received sympathetic stimulation of IFC, the second group received peripheral stimulation of IFC, and the third group (control) received placebo peripheral stimulation of IFC. A frequency of 80–100 Hz at an intensity of 10–20 mA was applied for 20 min. Blood volume pulse (BVP) amplitude was measured before IFC application using a plethysmography sensor at the big toe immediately after and 15 min poststimulation. The data were statistically analyzed and compared.

Results

There were statistically significant differences in BVP amplitude among the three time intervals in both the sympathetic and peripheral groups (P < 0.05) with no difference in the control group (P = 0.995). There was a significant increase in BVP amplitude immediately after stimulation compared with before stimulation in both the sympathetic and peripheral groups (P = 0.0001). However, differences between the sympathetic and peripheral groups at the three measured periods were statistically nonsignificant (P > 0.05).

Conclusion

Both IFC applications had a proper effect on improving BF in children with hemiplegic CP with no difference in efficacy between sympathetic and peripheral stimulation.

A 50 Hz magnetic field affects hemodynamics, ECG and vascular endothelial function in healthy adults: A pilot randomized controlled trial

Application of exposure to 50/60 Hz magnetic fields (MFs) has been conducted in the treatment of muscle pain and fatigue mainly in Japan. However, whether MFs could increase blood flow leading to muscle fatigue recovery has not been sufficiently tested. We investigated the acute effects of a 50 Hz sinusoidal MF at Bmax 180 mT on hemodynamics, electrocardiogram, and vascular endothelial function in healthy young men. Three types of regional exposures to a 50 Hz MF, i.e., forearm, upper arm, or neck exposure to MF were performed. Participants who received three types of real MF exposures had significantly increased ulnar arterial blood flow velocity compared to the sham exposures. Furthermore, after muscle loading exercise, MF exposure recovered hemoglobin oxygenation index values faster and higher than sham exposure from the loading condition. Moreover, participants who received real MF exposure in the neck region had significantly increased parasympathetic high-frequency activity relative to the sham exposure. The MF exposure in the upper arm region significantly increased the brachial artery flow-mediated dilation compared to the sham exposure. Computer simulations of induced in situ electric fields indicated that the order-of-magnitude estimates of the peak values were 100-500 mV/m, depending on the exposure conditions. This study provides the first evidence that a 50 Hz MF can activate parasympathetic activity and thereby lead to increase vasodilation and blood flow via a nitric oxide-dependent mechanism. Trial registration: UMIN Clinical Trial Registry (CTR) UMIN000038834. The authors confirm that all ongoing and related trials for this drug/intervention are registered.

Modulation of the Corticomotor Excitability by Repetitive Peripheral Magnetic Stimulation on the Median Nerve in Healthy Subjects

Objective: We aimed to examine the effects of repetitive peripheral nerve magnetic stimulation (rPNMS) on the excitability of the contralateral motor cortex and motor function of the upper limb in healthy subjects.

Methods: Forty-six healthy subjects were randomly assigned to either a repetitive peripheral nerve magnetic stimulation group (n = 23) or a sham group (n = 23). The repetitive peripheral nerve magnetic stimulation group received stimulation using magnetic pulses at 20 Hz, which were applied on the median nerve of the non-dominant hand, whereas the sham group underwent the same protocol without the stimulation output. The primary outcome was contralateral transcranial magnetic stimulation (TMS)-induced corticomotor excitability for the abductor pollicis brevis of the stimulated hand in terms of resting motor threshold (rMT), the slope of recruitment curve, and peak amplitude of motor evoked potential (MEP), which were measured at baseline and immediately after each session. The secondary outcomes were motor hand function including dexterity and grip strength of the non-dominant hand assessed at baseline, immediately after stimulation, and 24 h post-stimulation.

Results: Compared with the sham stimulation, repetitive peripheral nerve magnetic stimulation increased the peak motor evoked potential amplitude immediately after the intervention. The repetitive peripheral nerve magnetic stimulation also increased the slope of the recruitment curve immediately after intervention and enhanced hand dexterity after 24 h. However, the between-group difference for the changes was not significant. The significant changes in hand dexterity and peak amplitude of motor evoked potential after repetitive peripheral nerve magnetic stimulation were associated with their baseline value.

Conclusions: Repetitive peripheral nerve magnetic stimulation may modulate the corticomotor excitability together with a possible lasting improvement in hand dexterity, indicating that it might be helpful for clinical rehabilitation.

Finger skin blood perfusion during exposure of ulnar and median nerves to the static magnetic field of a rare-earth magnet: A randomized pilot study

This pilot study's goal was to investigate the impacts of static magnetic fields (SMF) on finger skin blood perfusion (SBP) when exposing the ulnar artery and ulnar and medial nerves to a rare earth concentric magnet for 30 minutes. Control SBP was measured in 4th fingers of adults (n = 12, age 26.0 ± 1.4 years) for 15 minutes using laser-Doppler. Then, active-magnets were placed over one arm's ulnar and median nerves at the wrist and sham-magnets placed at corresponding sites on the other arm. Devices were randomly assigned and placed by an investigator "blinded" to device type. The maximum SMF perpendicular to skin was 0.28 T measured 2 mm from magnet surface. The tangential field at this distance was 0.20 T. SBP was analyzed and tested for differential effects attributable to magnets compared to shams in each of the 5-minute intervals over the full 45-minute experiment. Results showed no statistically significant difference between SBP measured on the magnet-treated side compared to the sham side. Magnet and sham side SBP values (mean ± SEM, arbitrary units) prior to device placement were 0.568 ± 0.128 vs. 0.644 ± 0.115, p = .859 and during device placement were 0.627 ± 0.135 vs. 0.645 ± 0.117, p = .857. In conclusion, these findings have failed to uncover any significant effects of the static magnetic field on skin blood perfusion in the young healthy adult population evaluated. Its potential for altering SBP in more mature persons or those with underlying conditions affecting blood flow has not been evaluated but represents the next target of research inquiry. ClinicalTrials.gov registration number is NCT04539704.

Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients

Background

Glenohumeral subluxation (GHS) is common in patients with acute hemiplegia caused by stroke. GHS and upper limb function are closely related.

Objective

Using musculoskeletal ultrasonography (MSUS) to objectively evaluate the efficacy of functional magnetic stimulation (FMS) in the treatment of GHS in acute hemiplegic patients after stroke.

Methods

The study used prospective case control study. Stroke patients with GHS were recruited and assigned to control group and FMS group. Control group received electrode stimulation at the supraspinatus and deltoid muscles of the hemiplegic side, while FMS group was stimulated at the same locations. Before and after treatment, the distances of the acromion-greater tuberosity (AGT), acromion-lesser tuberosity (ALT), acromiohumeral distance (AHD), supraspinatus thickness (SST), and deltoid muscle thickness (DMT) in patients' bilateral shoulder joint were measured by MSUS, respectively. Meanwhile, Fugl-Meyer Assessment (FMA) was used to evaluate the improvement of upper limb function.

Results

30 patients were recruited. After FMS treatment, there was a significant decrease in the difference value between ipsilateral side and contralateral side of AGT [t = 8.595, P < 0.01], ALT [t = 11.435, P < 0.01], AHD [t = 8.375, P < 0.01], SST [t = 15.394, P < 0.01], and DMT [t = 24.935, P < 0.01], and FMA score increased [t = −13.315, P < 0.01]. Compared with control group, FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT [t = 2.161, P < 0.05], ALT [t = 3.332, P < 0.01], AHD [t = 8.768, P < 0.01], SST [t = 6.244, P < 0.01], and the DMT [t = 3.238, P < 0.01], and FMA score increased more significantly in FMS group [t = 7.194, P < 0.01].

Conclusion

The study preliminarily shows that the MSUS can objectively and dynamically evaluate the treatment effect of GHS in hemiplegic patients. Meanwhile, compared with control group, the FMS is more effective and has fewer side effects, and the long-term effect of FMS is worth further study. This trial is registered with ChiCTR1800015352.

Effect of Electrical Stimulation on Blood Flow Velocity and Vessel Size

Interferential current electrical stimulation alters blood flow velocity and vessel size. We aimed to investigate the changes in the autonomic nervous system depending on electrical stimulation parameters. Forty-five healthy adult male and female subjects were studied. Bipolar adhesive pad electrodes were used to stimulate the autonomic nervous system at the thoracic vertebrae 1-4 levels for 20 min. Using Doppler ultrasonography, blood flow was measured to determine velocity and vessel size before, immediately after, and 30 min after electrical stimulation. Changes in blood flow velocity were significantly different immediately and 30 min after stimulation. The interaction between intervention periods and groups was significantly different between the exercise and pain stimulation groups immediately after stimulation (p<0.05). The vessel size was significantly different before and 30 min after stimulation (p<0.05). Imbalances in the sympathetic nervous system, which regulates balance throughout the body, may present with various symptoms. Therefore, in the clinical practice, the parameters of electrical stimulation should be selectively applied in accordance with various conditions and changes in form.