Effects of rhythmic transcranial and multilevel magnetic stimulation on cognitive impairment in post-stroke patients

Abstract

Background. Cognitive impairment in post-stroke patients is often a major cause of social limitations. They seem insignificant and are masked by prominent post-stroke motor disorders, but negatively affect rehabilitation outcomes with loss of learning skills. Application of transcranial magnetic stimulation using multiple variations of schemes, its feature of noninvasive influence on the central and peripheral nervous system and modification of plasticity processes, appears effective for therapy in post-stroke patients, both in the acute and recovery periods. Aim. The aim of the study was to investigate the effect of the developed therapeutic techniques of rhythmic transcranial and multilevel magnetic stimulation on cognitive functions in post-stroke patients. Material and methods. An open placebo-controlled clinical trial of 102 post-stroke patients was conducted. Clinical data of patients, results of neuroimaging study, degree of paresis according to 6-point muscle strength rating scale, and level of cognitive impairment according to Mini-Mental State Examination-MMSE cognitive screening scale were analyzed. Two groups underwent multilevel and transcranial magnetic stimulation according to our developed methods, and the third group underwent false transcranial magnetic stimulation. Results and discussions. Evaluation of the MMSE scale scores after treatment revealed an increase in the mean scores on the items of orientation, perception, attention and calculation, memory, and speech in both treatment groups (p<0,05). There was a significant 17,8% increase in the cumulative mean score above 24 points in the group with multilevel magnetic stimulation, which was regarded as a significant positive effect in improving cognitive function. The distribution of the mean MMSE score by stroke recovery periods showed positive dynamics at all stages of the disease in the groups with multilevel and transcranial stimulation; no changes were detected in the placebo group. Conclusion. Application of therapeutic techniques of rhythmic transcranial and multilevel magnetic stimulation in poststroke patients contributes to improvement of clinical course of the disease, regression of motor deficiency, contributes to reduction of cognitive disorders such as disorders of memory, attention, orientation, speech, reading, reduction of inadaptation and due to this increases the level of everyday activity.