1 case of performing dysfunction in patients with cerebral hemorrhage sequelae in the base section of rTMS treatment

China has between 2 million and 2.5 million new stroke patients each yearThe incidence of cognitive dysfunction and executive dysfunction after stroke was highDuring the after-effects period of stroke, the incidence of cognitive dysfunction was 67.3% to 83%, of which the incidence of performing dysfunction was 30.7% to 66%Executive function refers to the complex cognitive process of individual stousan cognitive subsystem activity in a dynamic, flexible and optimized way in the implementation of purpose-oriented behavior, which is the advanced cognitive functionthe ability to self-regulate the thinking, emotion and behavior of patients with performing dysfunction, which seriously affects the rehabilitation of other dysfunctions, reduces the ability of daily life, and places a heavy burden on the family and societyAt present, there are limited treatments for post-stroke dysfunction and poor resultsMoreover, patients with execution dysfunction above Ia are less effective than Ia, so it is urgent to explore new effective methods for treating patients with post-stroke sequelaein recent years, repeated transcranial magnetic stimulation (RTMS) in the treatment of cognitive impairment after stroke showed better results, however, the field of treatment focused on side neglect, attention, memory and so on, only a small number of studies to explore the impact of rTMS on the function of stroke patients, especially for stroke after-effects of performing dysfunction is rareThe efficacy of rTMS multiple stimulation stoics on the function of performing the after-effects of stroke has not been reportedThe effect of high-frequency rTMS on the function of execution in patients with cerebral hemorrhage sequelae was observed in this study, and provided a preliminary basis for rTMS intervention function disorder1Data and methods1.1 Clinical data
patient male, 51 years old, secondary school culture, retiree, right handHe was admitted to hospital for "less than 1 year of memory loss with adverse right limb activity"Head CT at the onset of stroke: bleeding in the left base section areaThe history of hypertension has been a long timePhysical examination: body temperature 36.5 degrees C, pulse 65 times/min, breathing 18 times/min, blood pressure 150/93mmHg, clear mind, speech difficulties, comprehension, orientation, computational power, naming difficulties, understanding ability, memory, conflict suppression, problem-solving ability, etcreduction, right pain, temperature, tactile than the left side weakened, right muscle tension 1 level, right limb muscle strength 4Clinical diagnosis is: cerebral hemorrhage sequelae: right paraplegia, cognitive dysfunction, named aphasia, hypertension level 3 (extremely high-risk group)1.2 method1.2.1 Performing functional assessment method: using A Brief Mental State Examination (MMSE) and Montreal Cognitive Assessment (Montreal Edition) (MoCA) Primary Screening Cognitive ImpairmentThe ability to evaluate rapid visual search, visual spatial sequencing, and cognitive lynx is evaluated using digital breadth (digit span test, DST)The Color Trail Test (CTT) evaluates speech memory and attentionChinese version of the Paced auditory continuous addition test (PASAT) (in 3s and 2s) assessed continuous attention/alertness, information processing speed, and working memoryThe above tests were evaluated by the same researchers before treatment, 2 weeks after treatment and 4 weeks after treatment1.2.2 Routine rehabilitation training and drug treatment: patients continue to carry out rehabilitation training before admission, regular rehabilitation training and drug treatment after admission, including occupational therapy to improve upper limb muscle strength, joint activity, coordination, endurance, promote daily life and work ability recovery; At the same time to the nutritional nerve, reduce muscle tone, control blood pressure, regulate blood lipids and other drugs1.2.3 TMS treatment: the use of Ereed's CCYIA-type stimulator, "8" word coil, through the international 10-20 electroencephalography method in the skull marker positioning, motion threshold (Motor threshold, MT) for stimulation 10 at least 5 motion-induced electrocution range of more than 50 degrees of output is MTSelect the left back outer frontal prefrontal cortex (Dorsolateral prefrontal cortex, DLPFC) as the stimulation site, the specific positioning method is: (1) using two marker lines: the nasal pillow line is from the nose root to the pillow after the thick line, the top line is the two-sided outer ear hole of the connection, the junction of the two lines is the center of the head (Cz)(2) The coronaline line records 5 points from left to right (T3, C3, Cz, C4, T4), where the distance between C3 and C4 points is 20% crown line(3) After measurement, the threshold stimulation point position is C3 up 3 cm, 1 cm forward, the first 5 cm of the point is the outer cortex of the front alright, MT value of 35%(4) According to our clinical experience to select treatment parameters, stimulation intensity of 80% MT, that is, 28%, stimulation frequency of 5Hz, stimulation time 2s, interval time 1s, stimulation amount of 600 pulses 1 time/d, 3min/time, 5 times a week for 4 weeks Observe the patient's reaction during treatment, ask and record any discomfort at the end of treatment 2 Results 2.1 The results of the executive function assessment admitted to hospital, MoCA, CTT, PASAT all indicated that the patient had executive dysfunction, DST is normal After 2 weeks of rTMS treatment, MoCA total score, MoCA (visual space and executive function part), DST, PASAT (3s) improved PASAT (2s) scored less than the previous, and the rest of the scale scored no significant improvement After 4 weeks of rTMS treatment, MoCA (visual space and executive function) CTT, PASAT were significantly improved compared to the previous evaluation The DST score is the same as the previous one 2.2 Evaluation of patients' conscious symptoms
after 1 week of treatment, the patient himself and his family reflected the patient's attention, memory, reaction speed and so on, after the end of treatment, the patient himself and his family all believed that the patient's cognitive function has been significantly improved During treatment, the patient did not complain of discomfort See Table 1