Synergistic Effects of Scalp Acupuncture and Repetitive Transcranial Magnetic Stimulation on Cerebral Infarction: A Randomized Controlled Pilot Trial.

Jae-Hong Kim,Jae-Young Han,Gwang-Cheon Park,Min-Keun Song,Jeong-Soon Lee

doi:10.3390/brainsci10020087

Abstract

This study investigated the synergistic effects of scalp acupuncture (SA) and repetitive transcranial magnetic stimulation (rTMS), known to be effective for cerebral infarction. This outcome-assessor-blinded, randomized controlled clinical trial included a per-protocol analysis to compare the efficacy of SA and electromagnetic convergence stimulation (SAEM-CS) and single or no stimulation. The trial was conducted with 42 cerebral infarction patients (control group, 12; SA group, 11; rTMS group, 8; SAEM-CS group, 11). All patient groups underwent two sessions of CSRT per day. SA, rTMS, and SAEM-CS were conducted once per day, 5 days per week, for 3 weeks. The primary outcome was evaluated using the Fugl–Mayer assessment (FMA). FMA Upper Extremity, FMA total, MBI, and FIM scores significantly increased in the rTMS group compared with the control group. Additionally, FMA Upper Extremity, FMA total, MBI and FIM scores significantly increased in the rTMS group compared with the SAEM-CS group. However, there were no significant changes in the SA or SAEM-CS groups. In conclusion, low-frequency rTMS in the contralesional hemisphere may have long-term therapeutic effects on upper extremity motor function recovery and improvements in activities of daily living. SAEM-CS did not show positive synergistic effects of SA and rTMS.

Highlights

Stroke is the second most common cause of death and the leading cause of adult disability worldwide [1]
Sixty patients were included in this study and were randomly assigned to four groups: control group, 15; scalp acupuncture (SA) group, 15; repetitive transcranial magnetic stimulation (rTMS)
RTMS combined with conventional stroke rehabilitation therapy (CSRT) led to better improvements in Fugl–Mayer assessment (FMA), modified Barthel index (MBI), and functional independent measurement (FIM) than CSRT alone or SA and electromagnetic convergence stimulation (SAEM-CS) combined with CSRT

Summary

Introduction

Stroke is the second most common cause of death and the leading cause of adult disability worldwide [1]. Cerebral infarction (CI) is a common disease with high mortality, recurrence, and disability rates, which accounts for approximately 70% of strokes [2]. Conventional treatment of stroke patients includes pharmacological treatments, surgery, and multiprofessional rehabilitation. These treatments can promote recovery to some extent; no single intervention clearly and definitively contributes to stroke recovery. Neural plasticity refers to the ability of the brain to develop new neuronal connections, acquire new functions, and compensate for impairments. These processes are crucial for motor recovery after

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