Unsupervised Machine Learning Revealed that Repeat Transcranial Magnetic Stimulation is More Suitable for Stroke Patients with Statin

Abstract

Introduction Repeat transcranial magnetic stimulation (rTMS) demonstrates beneficial effects for stroke patients, though its efficacy varies due to the complexity of patient conditions and disease progression. Unsupervised machine learning could be the optimal solution for identifying target patients for transcranial magnetic stimulation treatment. Methods We collected data from ischaemic stroke patients treated with rTMS. Unsupervised machine learning methods, including K-means and Hierarchical Clustering, were used to explore the clinical characteristics of patients suitable for rTMS. We then utilized a prospective observational cohort to validate the effect of selected characteristics. For the validated cohort, outcomes included the presence of motor evoked potentials (MEP), favorable functional outcomes (FFO), and changes in the Fugl-Meyer Assessment (FMA) at 3 and 6 months. Results Hierarchical clustering methods revealed that patients in the better prognosis group were more likely to take statins. The validated cohort was grouped based on statin intake. Patients taking statins exhibited a higher rate of MEP ( p = 0.006), a higher rate of FFO at 3 months ( p = 0.003) and 6 months ( p = 0.021), and a more significant change in FMA ( p < 0.001) at both 3 and 6 months. Statin intake was associated with FFO and changes in FMA at 3 and 6 months. This relationship persisted across all subgroups for FMA changes and some FFO subgroups. Conclusion Stroke patients undergoing rTMS treatment taking statins exhibited greater MEP, FFO, and changes in FMA. Statin intake was associated with a better prognosis in these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-024-00615-8.