Effects of Repetitive Transcranial Magnetic Stimulation on Cerebral Autoregulation in Patients With Acute Ischemic Stroke

Study Overview
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Brief Summary
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The purpose of this study was to investigate the effect of repetitive transcranial magnetic stimulation on cerebral autoregulation in patients with acute ischemic stroke.

Detailed Description
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Current studies have shown that repetitive transcranial magnetic stimulation can change the excitability of nerve cells, improve intracerebral artery blood supply, and even reduce the degree of neurological impairment in patients with ischemic stroke. The purpose of this study was to investigate the effect of repetitive transcranial magnetic stimulation on cerebral autoregulation in patients with acute ischemic stroke.

Official Title
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Effects of Repetitive Transcranial Magnetic Stimulation on Cerebral Autoregulation in Patients With Acute Ischemic Stroke

Conditions
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Transcranial Magnetic Stimulation

Intervention / Treatment
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* Procedure: Repetitive transcranial magnetic stimulation
* Procedure: Sham repetitive transcranial magnetic stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age ≥ 18 years, both sexes; Clinically definite diagnosis of acute ischemic stroke; Baseline National Institute of Health Stroke Scale (NIHSS) score ≤25; Pre-onset modified Rankin Scale (mRS) score ≤1; Randomized and initiated transcranial magnetic stimulation within 1 week of onset; Subject or legal representative agreed to the treatment and signed the informed consent. Exclusion Criteria: Presence of a medical condition such as severe cognitive impairment or mental impairment; Patients with serious physical diseases or who have had craniocerebral surgery; Previous history of epilepsy, family history of epilepsy or presence of seizure provoking factors; Pregnancy or breastfeeding; The presence of metal foreign bodies near the stimulation site, such as intracranial metal implants, cochlear implants, built-in pulse generators (brain pacemakers, cardiac pacemakers), etc.; Patients who are unable to complete cerebral autoregulation, or bilateral temporal window penetration poorly; life expectancy of ≤3 months or inability to complete the study for other reasons; unwillingness to be followed up or poor treatment compliance; Those who are participating in other clinical investigators, or who have participated in other clinical studies within 3 months prior to enrollment, or who have participated in this study; Other conditions that the investigators deemed unsuitable for enrollment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: rTMS<br>Patients are treated with repetitive transcranial magnetic stimulation (rTMS). | Procedure: Repetitive transcranial magnetic stimulation<br>* After enrollment, patients received rTMS once a day for 5 consecutive days (stimulation plan: stimulation of M1 region on the affected side at 10Hz).<br>|
| Placebo Comparator: sham-rTMS<br>Patients are treated with sham repetitive transcranial magnetic stimulation (sham-rTMS). | Procedure: Sham repetitive transcranial magnetic stimulation<br>* After enrollment, patients received sham-rTMS once a day for 5 consecutive days with the same parameters as the rTMS group, but the coil was rotated 90° away from the scalp.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| phase difference(PD) in degree | A cerebral autoregulation parameter derived from transfer function analysis. Continuous cerebral blood flow velocities of bilateral middle cerebral artery will be assessed noninvasively using transcranial Doppler. Spontaneous arterial blood pressure will be simultaneously recorded using a servo-controlled plethysmograph on the left or right middle finger with an appropriate finger cuff size. Transfer function analysis will be used to derive the cerebral autoregulatory parameter. | 0-5 days |