High-Frequency repetitive transcranial magnetic stimulation enhances white matter integrity in a rat model of ischemic stroke: A diffusion tensor imaging study using tract-based spatial statistics

Ischemic stroke leads to white matter damage and neurological deficits. Previous studies have revealed that highfrequency repetitive transcranial magnetic stimulation (HF-rTMS) has beneficial effects on white matter reorganization and neurological recovery after stroke. However, the characteristics of poststroke white matter repair after treatment with HF-rTMS remain unclear. Therefore, this study used diffusion tensor imaging (DTI) to investigate the impact of HF-rTMS on white matter integrity following middle cerebral artery occlusion (MCAO) in a rat model. The modified neurological severity score (mNSS) and T2-weighted imaging data were used to assess neurological function and infarct size. We used a tract-based spatial statistics (TBSS) approach to analyze changes in fractional anisotropy (FA) across various white matter tracts. Furthermore, we performed Luxol fast blue (LFB) staining and transmission electron microscopy (TEM) to detect white matter and myelin damage. The results revealed that compared with the tMCAO group, the tMCAO+rTMS group presented a significant decrease in infarct size and the mNSS, as well as significantly greater FA values, mostly in the left external capsule, left internal capsule, left optic tract, left deep cerebral white matter, left stria terminalis and right external capsule. The LFB staining and electron microscopy results are consistent with the DTI results. These findings suggest that HF-rTMS contributes to the recovery of white matter integrity and neurological function. This study underscores the importance of HF-rTMS as a noninvasive intervention for enhancing poststroke neurological recovery by improving white matter integrity.