目的采用重复经颅磁刺激(rTMS)联合减重步行训练(BWSTT)治疗慢性不完全性脊髓损伤(SCI)的临床疗效观察。方法慢性不完全性SCI患者4例,先给予rTMS治疗后立即给予BWSTT训练。在治疗前、后以及治疗后第3周,分别进行临床功能评估。对其中2例患者进行H反射、功能性磁共振成像(fMRI)和静态平衡功能评估(BPM)。结果4例患者中有2例美国脊髓损伤协会(ASIA)运动及感觉评分、10m步行速度提高,步行费力程度减小,身体重心摆动路径和摆动面积均减小,改变持续到治疗后第3周。2例患者的电生理评估均显示H反射最大波幅降低,H/M最大波幅比下降。治疗后,2例患者的fMRI均显示M1区激活体积增大。结论高频rTMS联合BWSTT可能改善慢性不完全性SCI患者的运动功能,提高脊髓运动神经元的兴奋性并促进大脑皮质的重塑。
Objective To investigate the clinical effects of repetitive transcranial magnetic stimulation (rTMS) combined with body-weight-supported treadmill training (BWSTT) on patients with incomplete spinal cord injury (SCI). Methods Four patients with chronic incomplete SCI participated in this study. They were first trea- ted with rTMS and then BWSTT training. They were assessed with clinical measures of function. Two of the four pa- tients were assessed in terms of their H reflex, and using functional magnetic resonance imaging (fMRI) and a balance performance monitor ( BPM ). Results In two of the four patients, American spinal injury association (ASIA) clinical measures of motor and sensory function improved, as did 10 m walking speed and their sense of effort. In static balance tests, the sway path and sway area of the two patients both decreased. These improvements lasted for 3 weeks after the intervention. The two patients' maximum H reflex amplitude and the H/M amplitude ratio decreased. The fMRI results showed progressive enlargement of the activation volume of the movement-related M1 region after treat- ment. Conclusion High-frequency rTMS combined with BWSTT may improve motor function, elevate excitability of spinal motor neurons and improve the plasticity of the cerebral cortex in chronic incomplete SCI patients.