Low frequency rTMS and fluoxetine for motor recovery after ischemic stroke

低频 rTMS 和氟西汀用于缺血性中风后运动恢复

• 批准号: 8772945
• 负责人: Felipe Fregni
• 金额: $ 20.63万
• 依托单位: SPAULDING REHABILITATION HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8772945
• 关键词: Accounting; Activities of Daily Living; Affect; Age; American Heart Association; Area; Biological Neural Networks; Brain; Clinical; Combined Modality Therapy; Control Groups; Evaluation; Fluoxetine; Frequencies; Future; Goals; Intervention; Ischemic Stroke; Knowledge; Long-Term Potentiation; Measurement; Mental Depression; Motor; Motor Cortex; Motor Evoked Potentials; Motor Skills; Multicenter Trials; Neuronal Plasticity; Occupational Therapy; Patients; Pattern; Performance; Pharmacotherapy; Physical therapy; Physiologic pulse; Placebo Control; Placebos; Population; Process; Property; Recovery; Recruitment Activity; Rehabilitation therapy; Research; Research Project Grants; Role; Selective Serotonin Reuptake Inhibitor; Sertraline; Stroke; System; Testing; Therapeutic; Treatment Protocols; United States; base; disability; experience; functional outcomes; improved; indexing; motor function improvement; motor learning; neurophysiology; neuroregulation; post intervention; post stroke; public health relevance; repetitive transcranial magnetic stimulation; restoration; skill acquisition; stroke recovery; stroke rehabilitation; success

DESCRIPTION (provided by applicant): The goal of this proposal is to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with pharmacotherapy (fluoxetine) in the rehabilitation of post-stroke subjects. This research will help to reveal the relationship between function restorations via pharmacological intervention when combined with noninvasive neuromodulation in patients after ischemic stroke. Stroke is the leading cause of disability in the United States (Nowak et al., 2009) According to the American Heart Association, over 795,000 people experience stroke annually in the USA (Lloyd-Jones et al., 2009). Unfortunately, restitution of post-stroke motor function is frequently incomplete, with the majorit of stroke patients unable to perform professional duties or activities of daily living by six month after their stroke (Hummel and Cohen, 2006). Currently, there are only a few treatments available to improve motor function in stroke; most of them are based on motor learning strategies. Although these treatments may improve motor function significantly, their effects are often limited. The general objective of this research project is to assess the clinical and neurophysiological properties of rTMS and fluoxetine to promote motor recovery in post-stroke subjects as indexed by clinical motor function scales. This will be done by delivering low-frequency rTMS over the brain primary motor cortex (M1) in the unaffected hemisphere while the subjects are receiving fluoxetine treatment, subjects will be assessed at one and three months post intervention. Finally, we will investigate the mechanisms of this treatment by studying the induced neurophysiological and functional changes. This will be indexed by motor evoked potentials, cortical excitability/inhibition measurements, transcallosal inhibition evaluation, and paired associative stimulation. Regarding assurance of success, this proposal has two main specific aims: Aim 1: To determine whether low-frequency rTMS associated with fluoxetine offers additional benefits on motor rehabilitation and retention of motor skills, than pharmacotherapy alone. Aim 2: To determine the effects on cortical excitability when rTMS is combined with pharmacotherapy, whether fluoxetine is capable to induce positive or negative effects in M1 neuromodulation.

描述（由申请人提供）：该提案的目的是研究重复的经颅磁刺激（RTMS）与药物治疗（氟西汀）在恢复后受试者中的影响。这项研究将有助于揭示缺血性中风后患者无创神经调节的药理干预措施功能修复之间的关系。根据美国心脏协会的说法，中风是美国残疾的主要原因（Nowak等，2009），每年在美国有超过795,000人的中风（Lloyd-Jones等，2009）。不幸的是，势力后运动功能的恢复经常不完整，中风患者在中风后六个月就无法执行专业职责或日常生活的活动（Hummel and Cohen，2006年）。当前，只有少数可用的治疗方法可以改善中风的运动功能。他们中的大多数基于运动策略。尽管这些治疗方法可能会大大改善运动功能，但其作用通常受到限制。该研究项目的一般目标是评估RTMS和氟西汀的临床和神经生理特性，以促进临床运动功能尺度索引的中风后受试者的运动恢复。这将通过在受试者接受氟西汀治疗的同时，在不受影响的半球中在脑原发运动皮层（M1）上输送低频RTM，在干预后一个月和三个月内评估受试者。最后，我们将通过研究诱导的神经生理和功能变化来研究这种治疗的机制。这将由运动诱发电位，皮质兴奋性/抑制测量，透视抑制评估和配对的缔合刺激所索引。关于成功的保证，该提案具有两个主要的特定目的：目标1：确定与氟西汀相关的低频RTM是否比仅药物治疗对运动康复和保持运动技能的额外好处。 AIM 2：确定RTM与药物治疗结合使用的对皮质兴奋性的影响，氟西汀是否能够在M1神经调节中诱导阳性或负面影响。