Brain region changes following a spinal cord injury
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Corticospinal tract
Drug-naïve
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Background: The bimodal balance-recovery model predicts that corticospinal tract (CST) integrity in the affected hemisphere influences the partterns of brain recovery after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been used to promote functional recovery of stroke patients by modulating motor cortical excitability and inducing reorganization of neural networks. This study aimed to explore how to optimize the efficiency of repetitive transcranial magnetic stimulation to promote upper limb functional recovery after stroke according to bimodal balance-recovery model. Methods: 60 patients who met the inclusion criteria were enrolled to high CST integrity group (n = 30) or low CST integrity group (n = 30), and further assigned randomly to receive high-frequency rTMS (HF-rTMS), low-frequency rTMS (LF-rTMS) or sham rTMS in addition to routine rehabilitation, with 10 patients in each group. Outcome measures included Fugl-Meyer scale for upper extremity (FMA-UE), Wolf Motor Function (WMFT) scale and Modified Barthel Index (MBI) scale which were evaluated at baseline and after 21 days of treatment. Results: For patients with high CST integrity, the LF group achieved higher FMA-UE, WMFT and MBI scores improvements after treatment when compared to the HF group and sham group. For patients with low CST integrity, after 21 days treatment, only the HF group showed significant improvements in FMA-UE and WMFT scores. For MBI assessment, the HF group revealed significantly better improvements than the LF group and sham group. Conclusions: For stroke patients with high CST integrity, low-frequency rTMS is superior to high-frequency rTMS in promoting upper limb motor function recovery. However, only high-frequency rTMS can improve upper limb motor function of stroke patients with low CST integrity.
Corticospinal tract
Stroke
Pyramidal tracts
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We reviewed the literature on transcranial magnetic stimulation and its uses and efficacy in schizophrenia. Multiple sources were examined on transcranial magnetic stimulation efficacy in relieving positive and negative symptoms of schizophrenia. Literature review was conducted via Ovid Medline and PubMed databases. We found multiple published studies and metaanalyses that give evidence that repetitive transcranial magnetic stimulation can have benefit in relieving positive and negative symptoms of schizophrenia, particularly auditory hallucinations. These findings should encourage the psychiatric community to expand research into other applications for which transcranial magnetic stimulation may be used to treat patients with psychiatric disability.
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Facilitation
Silent period
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Brain stimulation
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Corticospinal tract
Stimulus (psychology)
Pyramidal tracts
Elbow flexion
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反復経頭蓋磁気刺激（repetitive transcranial magnetic stimulation，以下rTMS）は大きな変動磁場を頭皮上から引き起こすことで生じる渦電流が大脳皮質を刺激することを利用し，大脳皮質興奮性を変化させる特徴を有する．このrTMSの性質を利用し脳卒中，パーキンソン病，慢性疼痛などの中枢性疾患に対する治療報告が相次いでいる．リハビリテーション（以下，リハ）分野においては運動訓練だけでなく，強制使用，ボトックス治療，神経筋刺激を組み合わせることで脳卒中後運動麻痺を改善させる報告を認め，さらには言語訓練との併用が失語症に試みられつつある．大脳皮質興奮性を変化させることが可能なrTMSをリハ手法に併用することで，適切な可塑性を誘導し機能改善を引き出すことが期待されている．
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