Transcranial Magnetic Stimulation with Intermittent Theta Burst Stimulation Alters Corticospinal Output in Patients with Chronic Incomplete Spinal Cord Injury
Transcranial Magnetic Stimulation with Intermittent Theta Burst Stimulation Alters Corticospinal Output in Patients with Chronic Incomplete Spinal Cord Injury
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DOI：
10.3389/fneur.2017.00380
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发表时间：
2017-08-04
影响因子：
3.4
通讯作者：
Nelson, Aimee J.
中科院分区：
文献类型：
--
作者：
Fassett, Hunter J.;Turco, Claudia V.;Nelson, Aimee J.
间歇性Theta爆发刺激（iTBS）主要用于改变皮质脊髓兴奋性，为不完全性脊髓损伤（SCI）后改变神经输出创造了一个有吸引力的机会。这项研究是第一次评估iTBS在SCI中的作用。研究了8名慢性不完全性SCI患者。假的或真实的iTBS在单独的会话中通过初级运动和躯体感觉皮层递送（给每个参与者）。在iTBS之前和之后从桡侧腕屈肌获得运动诱发电位（MEP）募集曲线。结果表明，iTBS对运动和躯体感觉皮层的反应相似，56.25%的情况下MEP减少，25%的情况下MEP增加。假刺激超过了其余18.25%的真实的iTBS效应。我们认为，观察慢性SCI患者皮质脊髓输出的短期神经可塑性是一个重要的进步，应该在未来的研究中进行测试，作为改善这一人群功能的机会。我们强调，需要重新考虑MEP的方向变化的重要性，因为MEP方向和运动功能之间的关系是未知的，多个会话的iTBS可能会产生非常不同的方向结果。此外，我们强调了在实验设计中包括假手术对照的重要性。这项试点研究的基本观点是，一个单一的iTBS会话往往能够在SCI中产生短期变化。未来的假对照随机试验可能会考虑重复iTBS治疗，以促进皮质脊髓兴奋性的长期变化。
Intermittent theta burst stimulation (iTBS) is intended primarily to alter corticospinal excitability, creating an attractive opportunity to alter neural output following incomplete spinal cord injury (SCI). This study is the first to assess the effects of iTBS in SCI. Eight individuals with chronic incomplete SCI were studied. Sham or real iTBS was delivered (to each participant) over primary motor and somatosensory cortices in separate sessions. Motor-evoked potential (MEP) recruitment curves were obtained from the flexor carpi radialis muscle before and after iTBS. Results indicate similar responses for iTBS to both motor and somatosensory cortex and reduced MEPs in 56.25% and increased MEPs in 25% of instances. Sham stimulation exceeded real iTBS effects in the remaining 18.25%. It is our opinion that observing short-term neuroplasticity in corticospinal output in chronic SCI is an important advance and should be tested in future studies as an opportunity to improve function in this population. We emphasize the need to re-consider the importance of the direction of MEP change following a single session of iTBS since the relationship between MEP direction and motor function is unknown and multiple sessions of iTBS may yield very different directional results. Furthermore, we highlight the importance of including sham control in the experimental design. The fundamental point from this pilot research is that a single session of iTBS is often capable of creating short-term change in SCI. Future sham-controlled randomized trials may consider repeat iTBS sessions to promote long-term changes in corticospinal excitability.