重复经颅磁刺激对不完全性脊髓损伤患者痉挛的影响

Effects of repetitive transcranial magnetic stimulation on spasticity in patients with incomplete spinal cord injury

目的:观察高频重复经颅磁刺激(rTMS)对不完全性脊髓损伤(SCI)患者双下肢痉挛的影响。方法:对18例不完全性SCI患者作为SCI组,另取7例健康正常人作为正常组。给予SCI组进行rTMS治疗,采用"8"字形线圈rTMS刺激不完全性SCI患者(M1区),刺激强度为90%的RMT,刺激频率10Hz,共4周。观察其对患者下肢改良Ashworth痉挛评分(MAS)的影响,同时观察rTMS刺激治疗前后患者下肢F波的出现率、潜伏时(F-lat)、H反射潜伏时(H-lat)、H反射以及M波最大波幅比值(Hmax/Mmax值)等电生理指标的变化,同时与正常组做比较。结果:治疗后,SCI组下肢MAS分级较治疗前明显改善(P<0.05);SCI组治疗前F波和H反射潜伏时较正常组明显延长(P<0.05),Hmax/Mmax值较正常组增高(P<0.05);治疗后F波的平均潜伏时较治疗前减少(P<0.05),H反射潜伏时无显著差异,Hmax/Mmax值降低(P<0.05);SCI组F波出现率在治疗前后无差异性变化,Hmax/Mmax值和MAS之间无明显相关性。结论:rTMS治疗前后SCI患者的电生理和MAS指标变化,提示高频rTMS对治疗不完全性脊髓损伤患者下肢痉挛有一定的缓解作用,值得进一步的研究。

Objective：To observe the effects of high frequency repetitive transcranial magnetic stimulation（rTMS）on spasticity in patients with incomplete spinal cord injury（SCI）.Methods：Eighteen patients with incomplete SCI received 4weeks of daily sessions of active（n=18）rTMS on the leg motor area（10Hz and an intensity of 90% of resting motor threshold）.Seven healthy persons served as control group.All patients were assessed by the Modified Ashworth Scale（MAS）before and after rTMS treatment.In this study,we evaluated the effect of high frequency rTMS on the lower extremity spasticity and motor neuron excitability by comparing the difference in the mean latency of F wave（F-lat）and H reflex（H-lat）,the ratio of the maximum amplitude of H reflex and the maximum amplitude of M wave（Hmax/Mmax）of the patients before and after the rTMS treatment.Results：A significant improvement in lower limb spasticity which was assessed by the score of MAS was observed in patients after rTMS treatment（P〈0.05）.The F-lat-mean,H-lat-mean and Hmax/Mmax were significantly increased in the SCI group as compared with those in the control group（P〈0.05）.A significant decrease of Flat-mean was measured following active rTMS while H reflex and H/M did not change.There was no correlation before or after rTMS treatment between H/M and MAS respectively.Conclusion：High-frequency rTMS can improve spasticity in patients with incomplete SCI,and it can be assessed by several electrophysiological parameters such as F wave and H-reflex.It is suggested that high frequency rTMS can be used as a possible useful treatment for incomplete SCI patients,and it is also worth to be studied further.