Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Aerobic Exercise on the Recovery of Motor Function in Ischemic Stroke Rat Model

Abstract

The therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS) combined with rehabilitation therapy on recovery after stroke have not been fully elucidated. This study aimed to explore the therapeutic effects of rTMS followed by aerobic exercise on neuroplasticity and recovery of motor function in a rat model of permanent middle cerebral artery occlusion (MCAO). Rats were randomized into sham operation (N = 10, sham op), MCAO (N = 10, control group), rTMS (N = 10, MCAO and rTMS therapy), and combination groups (N = 10, MCAO and combination therapy). High-frequency rTMS (10 Hz) was applied on the ipsilesional forepaw motor cortex, and aerobic exercise training on the rotarod was performed for two weeks. The rotarod and Garcia tests were conducted to evaluate changes in behavioral function. Motor evoked potentials (MEPs) were used to evaluate electrophysiological changes. Stroke severity was assessed using infarction volume measurement. Neuronal recovery was explored with western blot for brain-derived neurotrophic factor (BDNF) pathway proteins. Compared with control therapy, combination therapy was significantly more effective than rTMS therapy for improving function on the rotarod test (p = 0.08), Garcia test (p = 0.001), and MEP amplitude (p = 0.001) In conclusion, combination therapy may be a potential treatment to promote recovery of motor function and neuroplasticity in stroke patients.

In Search of a Dose: The Functional and Molecular Effects of Exercise on Post-stroke Rehabilitation in Rats

“…The present results were largely supported by the findings of other groups, which demonstrated that exercise accelerated CBF (Pianta et al, 2019), decreased infarct volume (Tian et al, 2013;Pan et al, 2020) and improved functional outcomes (Pianta et al, 2019). In contrast, a few studies have reported no neuroprotective effects of exercise on the neurological deficit and infarct volume after stroke within 3 days (Matsuda et al, 2011;Cui et al, 2020). Future studies are necessary to fully elucidate the effect of post-stroke exercise on brain injury.…”

Neuroprotective Effects of Exercise Postconditioning After Stroke via SIRT1-Mediated Suppression of Endoplasmic Reticulum (ER) Stress

“…The present results were further supported by the results of other groups, which indicated that various types and intensities of early exercise postconditioning accelerated CBF (Pianta et al, 2019 ), decreased infarct volume (Tian et al, 2013 ; Pan et al, 2020 ) and improved functional outcomes (Pianta et al, 2019 ). However, a few studies claimed that no obvious improvements were found after post-stroke exercise treatment on brain infarct and recovery (Matsuda et al, 2011 ; Cui et al, 2020 ). These studies employed models of 90-min ischemia or permanent MCAO models in their exercise procedures, whereas we used a model of 120 min temporary ischemia and induced a relatively small size of infarction.…”

Neurostimulation for Stroke Rehabilitation

“…This is of interest since phasic GABAergic signaling is a potential target for drug therapeutics in mice (Hiu et al, 2016). TMS combined with exercise significantly increased expression of Brain-Derived Neurotrophic Factor and TrkB after middle cerebral artery occlusion in rats (Cui et al, 2020). Hogan and colleagues have written a useful review concerning the molecular mechanisms resulting from neural stimulation and those involving neural plasticity (Hogan et al, 2020).…”