中国神经再生研究(英文版) ›› 2022, Vol. 17 ›› Issue (8): 1821-1826.doi: 10.4103/1673-5374.332158

• 原著:脊髓损伤修复保护与再生 • 上一篇    下一篇

皮质间歇性θ脉冲刺激联合精确神经根刺激对脊髓损伤后运动功能的影响:病例系列研究

  

  • 出版日期:2022-08-15 发布日期:2022-01-22
  • 基金资助:
    国家重点研发计划项目(2020YFC2004202);国家自然科学基金项目(81974358,81772453)

Effects of cortical intermittent theta burst stimulation combined with precise root stimulation on motor function after spinal cord injury: a case series study

Ye-Ran Mao1, 2, #, Zhong-Xia Jin3, #, Ya Zheng4, Jian Fan5, Li-Juan Zhao4, Wei Xu4, Xiao Hu4, Chun-Ya Gu4, Wei-Wei Lu4, Guang-Yue Zhu4, Yu-Hui Chen4, Li-Ming Cheng4, 6, *, Dong-Sheng Xu2, 7, *   

  1. 1Department of Rehabilitation, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China; 2Institute of Rehabilitation Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China; 3Department of Spinal Cord Injury Rehabilitation, Shanghai Yangzhi Rehabilitation Hospital, Shanghai Sunshine Rehabilitation Center, Tongji University School of Medicine, Shanghai, China; 4Spine Surgery Division of Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China; 5Surgery Division of Department of Orthopedics, Tongji Hospital Affiliated to Tongji University School of Medicine, Shanghai, China; 6Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration, Ministry of Education, Shanghai, China; 7Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
  • Online:2022-08-15 Published:2022-01-22
  • Contact: Dong-Sheng Xu, MD, dxu0927@shutcm.edu.cn; Li-Ming Cheng, PhD, chlm.d@163.com.
  • Supported by:
    This study was supported by National Key R&D Program of China, No. 2020YFC2004202; and the National Natural Science Foundation of China, Nos. 81974358 and 81772453 (all to DSX).

摘要:

脊髓回路的激活和重建是改善脊髓损伤运动功能的重要途径。为了探索皮质间歇性θ脉冲刺激联合精确神经根刺激治疗不同患者运动功能的改善情况,此次病例系列研究在2020年3-10月于上海养志医院招募了14例慢性脊髓损伤患者,接受连续4周,每周接受 5 次右侧皮质间歇性θ脉冲刺激联合两侧损伤区下游L3-4精确神经根刺激。结果显示,两侧静息态运动诱发电位振幅增加,且右侧中枢运动传导时间发生显著变化减少,同时患者下肢运动功能评分、Berg平衡量表评分、脊髓独立性评定量表Ⅲ评分和10m步行速度在治疗后发生明显改善。相关性分析结果显示,治疗后4周时患者右侧静息态运动诱发电位振幅与下肢运动功能评分存在正相关。因此提示皮质间歇性θ脉冲刺激联合精确神经根刺激有利于慢性脊髓损伤患者皮质脊髓束的神经传导和下肢运动功能的恢复。

https://orcid.org/0000-0002-8477-5377 (Dong-Sheng Xu)

关键词: 脊髓损伤, 经颅磁刺激, 神经调节, 运动诱发电位, 间歇性θ脉冲刺激, 神经元, 可塑性, 中枢运动传导时间, 下肢运动评分

Abstract: Activation and reconstruction of the spinal cord circuitry is important for improving motor function following spinal cord injury. We conducted a case series study to investigate motor function improvement in 14 patients with chronic spinal cord injury treated with 4 weeks of unilateral (right only) cortical intermittent theta burst stimulation combined with bilateral magnetic stimulation of L3–L4 nerve roots, five times a week. Bilateral resting motor evoked potential amplitude was increased, central motor conduction time on the side receiving cortical stimulation was significantly decreased, and lower extremity motor score, Berg balance score, spinal cord independence measure-III score, and 10 m-walking speed were all increased after treatment. Right resting motor evoked potential amplitude was positively correlated with lower extremity motor score after 4 weeks of treatment. These findings suggest that cortical intermittent theta burst stimulation combined with precise root stimulation can improve nerve conduction of the corticospinal tract and lower limb motor function recovery in patients with chronic spinal cord injury.

Key words: central motor conduction time, intermittent theta burst, lower extremity motor score, motor evoked potential stimulation, neuromodulation, neuronal plasticity, spinal cord injury, transcranial magnetic stimulation