Reduction of Spasticity With Repetitive Transcranial Magnetic Stimulation in Patients With Spinal Cord Injury
Reduction of Spasticity With Repetitive Transcranial Magnetic Stimulation in Patients With Spinal Cord Injury
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DOI：
10.1177/1545968309356095
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发表时间：
2010-06-01
影响因子：
4.2
通讯作者：
Pascual-Leone, Alvaro
中科院分区：
文献类型：
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作者：
Kumru, Hatice;Murillo, Narda;Pascual-Leone, Alvaro
Objective.脊髓损伤（SCI）后的痉挛状态与张力增加和痉挛是常见的。通常发挥脊髓节段控制作用的下行皮质脊髓通路的损伤被认为在痉挛中起重要的因果作用。作者研究了高频重复经颅磁刺激（rTMS）对初级运动皮层兴奋性的调节是否可以改善不完全SCI患者的下肢痉挛。方法.患者通过改良Ashworth量表、视觉焦虑量表和脊髓损伤痉挛评估工具（SCI-SET）进行评估，并通过H-max/M-max、T反射和退缩反射测量皮质脊髓和节段兴奋性。15例患者接受5天的活动（n = 14）或假（n = 7）rTMS的腿部运动区（20列40脉冲，20 Hz和强度的90%的肱二头肌肌肉静息运动阈值）的日常会话。结果.在主动rTMS后患者中观察到下肢痉挛的显著临床改善，但在假刺激后未观察到。这种改善在干预后至少持续了一周。神经生理学研究没有变化。结论.腿部运动区的高频rTMS可以改善不完全SCI患者的痉挛状态。
Objective. Spasticity with increased tone and spasms is frequent in patients after spinal cord injury (SCI). Damage to descending corticospinal pathways that normally exert spinal segmental control is thought to play an important causal role in spasticity. The authors examined whether the modulation of excitability of the primary motor cortex with high-frequency repetitive transcranial magnetic stimulation (rTMS) could modify lower limb spasticity in patients with incomplete SCI. Methods. Patients were assessed by the Modified Ashworth Scale,Visual Analogue Scale, and the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) and neurophysiologically with measures of corticospinal and segmental excitability by the H-max/M-max,T reflex, and withdrawal reflex. Fifteen patients received 5 days of daily sessions of active (n = 14) or sham (n = 7) rTMS to the leg motor area (20 trains of 40 pulses at 20 Hz and an intensity of 90% of resting motor threshold for the biceps brachii muscle). Result. A significant clinical improvement in lower limb spasticity was observed in patients following active rTMS but not after sham stimulation. This improvement lasted for at least I week following the intervention. Neurophysiological studies did not change. Conclusions. High-frequency rTMS over the leg motor area can improve aspects of spasticity in patients with incomplete SCI.