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Neurology and Therapy

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Open Access 30-04-2024 | Repetitive Transcranial Magnetic Stimulation | ORIGINAL RESEARCH

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

Authors: Chaohua Cui, Changhong Li, Tonghua Long, Zhenxian Lao, Tianyu Xia

Published in: Neurology and Therapy | Issue 3/2024

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.

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Hebert D, Lindsay MP, McIntyre A, et al. Canadian stroke best practice recommendations: stroke rehabilitation practice guidelines, update 2015. Int J Stroke. 2016;11:459–84. https://doi.org/10.1177/1747493016643553.CrossRefPubMed

Boddington LJ, Reynolds JNJ. Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation. Brain Stimul. 2017;10:214–22. https://doi.org/10.1016/j.brs.2017.01.006.CrossRefPubMed

Zhang L, Xing GQ, Fan YL, et al. Short- and long-term effects of repetitive transcranial magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis. Clin Rehabil. 2017;31:1137–53. https://doi.org/10.1177/0269215517692386.CrossRefPubMed

Starosta M, Cichon N, Saluk-Bijak J, et al. Benefits from repetitive transcranial magnetic stimulation in post-stroke rehabilitation. J Clin Med. 2022. https://doi.org/10.3390/jcm11082149.CrossRefPubMedPubMedCentral

Cui CH, Li YC, Liu SH, et al. The unsupervised machine learning to analyze the use strategy of statins for ischaemic stroke patients with elevated transaminase. Clin Neurol Neurosurg. 2023. https://doi.org/10.1016/j.clineuro.2023.107900.CrossRefPubMed

Cui CH, Li CH, Hou M, et al. The machine learning methods to analyze the using strategy of antiplatelet drugs in ischaemic stroke patients with gastrointestinal haemorrhage. BMC Neurol. 2023. https://doi.org/10.1186/s12883-023-03422-0.CrossRefPubMedPubMedCentral

Tozlu C, Edwards D, Boes A, et al. Machine learning methods predict individual upper-limb motor impairment following therapy in chronic stroke. Neurorehabil Neural Repair. 2020;34:428–39. https://doi.org/10.1177/1545968320909796.CrossRefPubMedPubMedCentral

Chang MC, Do KH, Chun MH. Prediction of lower limb motor outcomes based on transcranial magnetic stimulation findings in patients with an infarct of the anterior cerebral artery. Somatosens Mot Res. 2015;32:249–53. https://doi.org/10.3109/08990220.2015.1091769.CrossRefPubMed

Jin R, Yang GJ, Li GH. Inflammatory mechanisms in ischemic stroke: role of inflammatory cells. J Leukoc Biol. 2010;87:779–89. https://doi.org/10.1189/jlb.1109766.CrossRefPubMedPubMedCentral

10.

Wimmer I, Zrzavy T, Lassmann H. Neuroinflammatory responses in experimental and human stroke lesions. J Neuroimmunol. 2018;323:10–8. https://doi.org/10.1016/j.jneuroim.2018.07.003.CrossRefPubMed

11.

Pan LJ, Zhu HQ, Zhang XA, et al. The mechanism and effect of repetitive transcranial magnetic stimulation for post-stroke pain. Front Mol Neurosci. 2023. https://doi.org/10.3389/fnmol.2022.1091402.CrossRefPubMedPubMedCentral

12.

Pahan K, Sheikh FG, Namboodiri AMS, et al. Lovastatin and phenylacetate inhibit the induction of nitric oxide synthase and cytokines in rat primary astrocytes, microglia, and macrophages. J Clin Investig. 1997;100:2671–9. https://doi.org/10.1172/jci119812.CrossRefPubMedPubMedCentral

13.

Luo L, Liu MX, Fan YH, et al. Intermittent theta-burst stimulation improves motor function by inhibiting neuronal pyroptosis and regulating microglial polarization via TLR4/NFκB/NLRP3 signaling pathway in cerebral ischemic mice. J Neuroinflamm. 2022. https://doi.org/10.1186/s12974-022-02501-2.CrossRef

14.

Stanislaus R, Singh AK, Singh I. Lovastatin treatment decreases mononuclear cell infiltration into the CNS of Lewis rats with experimental allergic encephalomyelitis. J Neurosci Res. 2001;66:155–62. https://doi.org/10.1002/jnr.1207.CrossRefPubMed

15.

Walters CE, Pryce G, Hankey DJR, et al. Inhibition of Rho GTPases with protein prenyltransferase inhibitors prevents leukocyte recruitment to the central nervous system and attenuates clinical signs of disease in an animal model of multiple sclerosis. J Immunol. 2002;168:4087–94. https://doi.org/10.4049/jimmunol.168.8.4087.CrossRefPubMed

16.

Ruohonen J, Karhu J. tDCS possibly stimulates glial cells. Clin Neurophysiol. 2012;123:2006–9. https://doi.org/10.1016/j.clinph.2012.02.082.CrossRefPubMed

17.

Arboix A, García-Eroles L, Oliveres M, et al. Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke: a pleiotropic effect of statins or a beneficial effect of hypercholesterolemia? BMC Neurol. 2010. https://doi.org/10.1186/1471-2377-10-47.CrossRefPubMedPubMedCentral

18.

Biffi A, Devan WJ, Anderson CD, et al. Statin treatment and functional outcome after ischemic stroke case-control and meta-analysis. Stroke. 2011;42:1314–9. https://doi.org/10.1161/strokeaha.110.605923.CrossRefPubMedPubMedCentral

19.

Wu JJ, Xiong H, Chen J. Towards understanding hierarchical clustering: a data distribution perspective. Neurocomputing. 2009;72:2319–30. https://doi.org/10.1016/j.neucom.2008.12.011.CrossRef

20.

Ntaios G, Weng SF, Perlepe K, et al. Data-driven machine-learning analysis of potential embolic sources in embolic stroke of undetermined source. Eur J Neurol. 2021;28:192–201. https://doi.org/10.1111/ene.14524.CrossRefPubMed

21.

Youssef S, Stüve O, Patarroyo JC, et al. The HMG-CoA reductase inhibitor, atorvastatin, promotes a Th2 bias and reverses paralysis in central nervous system autoimmune disease. Nature. 2002;420:78–84. https://doi.org/10.1038/nature01158.CrossRefPubMed

22.

Tai SY, Lin FC, Lee CY, et al. Statin use after intracerebral hemorrhage: a 10-year nationwide cohort study. Brain Behav. 2016. https://doi.org/10.1002/brb3.487.CrossRefPubMedPubMedCentral

23.

Arboix A, Padilla I, Massons J, et al. Clinical study of 222 patients with pure motor stroke. J Neurol Neurosurg Psychiatry. 2001;71:239–42. https://doi.org/10.1136/jnnp.71.2.239.CrossRefPubMedPubMedCentral

Title: Unsupervised Machine Learning Revealed that Repeat Transcranial Magnetic Stimulation is More Suitable for Stroke Patients with Statin
Authors: Chaohua Cui
Changhong Li
Tonghua Long
Zhenxian Lao
Tianyu Xia
Publication date: 30-04-2024
Publisher: Springer Healthcare
Keywords: Repetitive Transcranial Magnetic Stimulation
Statins
Motor Evoked Potential
Motor Evoked Potential
Stroke
Transcranial Magnetic Stimulation
Transcranial Magnetic Stimulation
Published in: Neurology and Therapy / Issue 3/2024
Print ISSN: 2193-8253
Electronic ISSN: 2193-6536
DOI: https://doi.org/10.1007/s40120-024-00615-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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