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Clinical study of repetitive transcranial magnetic stimulation in the rehabilitation of post-stroke depression: A Quantitative Insomnia Sleep Inventory monitoring evaluation
Ai-Ming Gu, Chao Liu, Jian-Hong Chen, Ru-Ya Guo, Chao Liang, Xing-Shi Chen
Ai-Ming Gu, Department of Neurology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, Zhejiang Province, China
Chao Liu, Department of Psychiatry, The First Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
Jian-Hong Chen, Department of Medical, Jinhua City Durg Rehabilitation Isolation Center, Jinhua 321000, Zhejiang Province, China
Ru-Ya Guo, Department of Endocrinology, The First Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
Chao Liang, Department of General Practice, The First Hospital of Jiaxing, Jiaxing 314000, Zhejiang Province, China
Xing-Shi Chen, Department of Electrophysiology, Shanghai Mental Health Center, Shanghai 200030, China
Co-first authors: Ai-Ming Gu and Chao Liu.
Co-corresponding authors: Jian-Hong Chen and Ru-Ya Guo.
Author contributions: Gu AM and Chen JH designed the study; Gu AM, Guo RY, and Chen XS conducted the research; Chen JH and Chen XS provided experimental instruments; Liu C, Chen JH, and Liang C analyzed the data and drafted the manuscript; Gu AM and Liu C contributed equally to this manuscript and are co-first authors; Chen JH and Guo RY contributed equally to this manuscript and are co-corresponding authors. All authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81471357; and the Project of Jinhua Municipal Bureau of Science and Technology, No. 2024-07 and No. 2024-08.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of Shanghai Mental Health Center (Approval No. 2019009).
Informed consent statement: All participants in the study signed the informed consent form before commencement of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Jian-Hong Chen, Department of Medical, Jinhua City Durg Rehabili
tation Isolation Center, No. 1 Fangjingtou Community, Fangjingtou Village, Wucheng District, Jinhua 321000, Zhejiang Province, China.
18713190@qq.com
Received: November 7, 2025
Revised: December 8, 2025
Accepted: February 5, 2026
Published online: March 19, 2026
Processing time: 111 Days and 23.1 Hours
BACKGROUND
Jiaxing Hospital of Traditional Chinese Medicine introduced transcranial magnetic stimulation (TMS) technology in 2019. In practical application, it was found that different types of equipment and technical parameters could lead to differences in therapeutic effects. Therefore, our hospital selected a Danish-made TMS device, which ranked second in the Chinese market, and conducted tests on patients with post-stroke depression (PSD) from March 2019 to September 2023. Before the test, a plan was formulated based on the quality status before and after the inspection. Two evaluators independently controlled the quality of the plan. The repetitive TMS (rTMS) and Quantitative Insomnia Sleep Inventory (QUISI) data were separately stored and verified independently by the two evaluators.
AIM
To investigate the effect of rTMS and QUISI on the sleep and rehabilitation of patients with PSD.
METHODS
From March 2019 to December 2023, subjects who were admitted to the Department of Rehabilitation of the Jiaxing Hospital of Traditional Chinese Medicine, Shanghai Mental Health Center, and National Medical Centre for Psychiatric Disorders were enrolled. A total of 108 patients with PSD were enrolled: 54 patients in the observation group and 54 in the control group. Sixty-eight normal volunteers were also included. Both the observation group and the control group received venlafaxine 150 mg/day sustained-release therapy. The observation group was given venlafaxine combined with rTMS. The control group was treated with venlafaxine combined with rTMS pseudo stimulation. The two groups underwent 42 treatment sessions over 14 weeks. The Hamilton Depression Rating Scale-17 scores were compared between the two groups before and after treatment, and the changes in QUISI were compared with healthy volunteers.
RESULTS
The Hamilton Depression Rating Scale-17 scores in the two groups were significantly reduced after treatment, and the improvement was more significant in the observation group (P < 0.05). Before treatment, the sleep latency in the two groups of patients by QUISI was delayed compared to normal volunteers, and the sleep efficiency and maintenance rate were lower than those in normal volunteers, with statistical significance (P < 0.05-0.01). After 14 weeks of treatment, the sleep latency period in the observation group QUISI shifted forward, indicating an increase in sleep efficiency and maintenance rate. The differences between the observation group and the control group were statistically significant (P < 0.01). After a 3-month rehabilitation evaluation, the total effective rate of patients in the observation group was significantly higher than that in the control group (P < 0.05).
CONCLUSION
rTMS treatment has a positive effect on PSD in clinical practice. QUISI monitoring can be used for rehabilitation assessment.
Core Tip: This study examined the role of combined application of repetitive transcranial magnetic stimulation (rTMS) and Quantitative Insomnia Sleep Inventory (QUISI) in the rehabilitation of post-stroke depression (PSD). Innovations included designing experiments based on China’s rTMS standards, using QUISI to evaluate therapeutic effects, developing monitoring protocols and quality plans, and adjusting technical parameters. The results showed that rTMS significantly increased the recovery and effective rates of PSD patients (evidenced by reduced Hamilton Depression Rating Scale-17 scores, and improved QUISI sleep efficiency and maintenance rate in the observation group). Thus, rTMS is effective for PSD, and QUISI can be used for rehabilitation assessment.
