Structural and functional abnormalities of the prefrontal cortex seem to correlate with fatigue in patients with chronic fatigue syndrome (CFS). We consecutively applied facilitatory high-frequency repetitive transcranial magnetic stimulation (rTMS) to the dorsolateral prefrontal cortex (DLPFC) of seven CFS patients over three days. Five patients completed the 3-day protocol without any adverse events. For the other two patients, we had to reduce the stimulation intensity in response to mild adverse reactions. In most of the patients, treatment resulted in an improvement of fatigue symptoms. High-frequency rTMS applied over the DLPFC can therefore be a potentially useful therapy for CFS patients.

Objectives: Recently, repetitive transcranial magnetic stimulation (rTMS) has been therapeutically applied for patients with myalgic encephalomyelitis (ME). However, it is still unclear which clinical factors could influence the efficacy of rTMS for ME patients. The purpose of this study is to clarify whether baseline severity of fatigue symptom would influence the efficacy of rTMS applied for ME patients. Methods: Twenty-two patients with ME were studied. Each patient was hospitalized to receive 6-8 sessions of rTMS. In this study, high-frequency rTMS of 10 hertz was applied over prefrontal cortex. To evaluate the severity of fatigue symptom, Brief Fatigue Inventory (BFI) score and Visual Analogue Scale (VAS) rate were applied before and after rTMS application. Based on the BFI score before rTMS, the patients were divided into 2 groups, “severe group” (n = 9) and “mild group” (n = 13). We compared the extent of the improvements of fatigue symptom between 2 groups. Results: In severe group, compared to before rTMS, VAS rate was significantly lower not only at discharge but also 2 weeks after discharge. Similarly, mild group also showed significant decrease in VAS rate at the same timepoints. However, the extent of VAS rate change didn’t differ between 2 groups. In addition, no significant correlation between baseline score of BFI and the changes in VAS rate was indicated. Conclusions: It can be concluded that rTMS can improve fatigue symptom in ME patients regardless of baseline severity of fatigue symptom. It is expected that rTMS can be a novel therapeutic intervention for ME patients.

【背景】本邦における脳卒中急性期リハビリテーション（以下，リハ）の現状については，確固たるデータが存在しない．【方法】2022年2月7日から同年4月21日までに一次脳卒中センター959施設を対象として，“脳卒中急性期リハの現状”を問うwebアンケート調査を行った．【結果】639施設（回答率：66.6%）から有効回答が得られた．リハ科専門医，脳卒中リハ看護認定看護師が配置されている施設はそれぞれ41%, 45%にすぎなかった．初回介入時のリハ訓練量は2単位（40分間）/日である施設が多かった．休診/休院日においてリハ訓練が行われていない施設は全体の37%であった．61%の施設では，COVID-19の流行が脳卒中急性期リハに影響を与えていた．【結論】本邦では脳卒中急性期リハの提供が十分ではない可能性があり，今後は急性期リハの均てん化と標準化を図ることが課題である．

Objectives: In Japan, acute stroke rehabilitation has been expanding more steadily than previously with the nationwide establishment of primary stroke centers. However, Japan previously had no established guidelines for the rehabilitation. Consequently, rehabilitation programs and the provision systems for acute stroke varied among the facilities. To equalize and standardize acute stroke rehabilitation in Japan, it is necessary to develop clinical recommendations for rehabilitation. Therefore, the rehabilitation project team of the Japan Stroke Society aimed to develop the first recommendations for acute stroke rehabilitation in Japan.Methods: The recommendations are based on the results of a survey on the current status of acute stroke rehabilitation at primary stroke centers in Japan, which was completed in 2022, and on a literature review conducted by the rehabilitation project team.Results: The recommendations consist of 19 clinical questions regarding the following topics of acute stroke rehabilitation: (1) head elevation and mobilization training, (2) acute complications, (3) training time and frequency for acute stroke rehabilitation, (4) dysphagia in the acute phase, and (5) acute rehabilitation during pandemics of novel and re-emerging infections, particularly novel coronavirus disease 2019 (COVID-19). The team members agreed on all answers for these 19 clinical questions.Conclusions: These recommendations suggest broad principles of rehabilitative intervention in the acute phase of stroke. In the near future, it is expected that the dissemination of these recommendations will result in an increase in the quality of acute stroke rehabilitation in Japan.