重復性經顱磁刺激用于脊髓損傷康復的研究進展_West China Medical Journal

Authors：

張嘉祺 , 廖伶藝 , 楊福 , 康有存 , 唐芯 ,  楊永紅

四川大學華西醫院康復醫學中心（成都? 610041）;

Corresponding?author：

楊永紅, Email: nicole308@126.com

Keywords：

重復經顱磁刺激; 脊髓損傷; 康復

DOI：

10.7507/1002-0179.201607192

Video：

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脊髓損傷后由于中樞神經系統的可塑性改變，機體從脊髓損傷平面到上位神經通路均出現一系列繼發改變，而這一系列繼發改變可能引發脊髓損傷患者的神經病理性疼痛，延緩其運動功能、痙攣狀態的恢復過程。因此，對中樞神經系統進行適當的引導和調制將促進患者的康復進程。重復性經顱磁刺激目前已經廣泛應用于多種臨床康復問題之中，通過無創地影響中樞神經系統活性，調制神經系統重塑，該技術可望成為脊髓損傷康復管理的可選干預措施之一。該文就目前重復性經顱磁刺激對脊髓損傷康復的研究進行綜述，并探究其可能的機制和臨床實際使用方法，以期促進該技術在脊髓損傷康復中的臨床應用。

Citation： 張嘉祺, 廖伶藝, 楊福, 康有存, 唐芯, 楊永紅. 重復性經顱磁刺激用于脊髓損傷康復的研究進展. West China Medical Journal, 2017, 32(10): 1624-1628. doi: 10.7507/1002-0179.201607192 Copy

1.	Kobayashi M, Pascual-Leone A. Transcranial magnetic stimulation in neurology. Lancet Neurol, 2003, 2(3): 145-156.
2.	李江濤, 鄭敏軍, 曹輝, 等. 經顱磁刺激技術的研究進展. 高電壓技術, 2016, 42(4): 1168-1178.
3.	Pinter MM, Brainin M. Role of repetitive transcranial magnetic stimulation in stroke rehabilitation. Front Neurol Neurosci, 2013, 32: 112-121.
4.	王樸, 張嘉祺, 余佳丹, 等. 重復經顱磁刺激治療腦卒中患者失語癥效果的系統評價. 中國循證醫學雜志, 2014, 14(12): 1497-1503.
5.	Liao X, Xing G, Guo Z, et al. Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke: a systematic review and meta-analysis. Clin Rehabil, 2017, 31(3): 289-298.
6.	Chou YH, Hickey PT, Sundman M, et al. Effects of repetitive transcranial magnetic stimulation on motor symptoms in Parkinson disease: a systematic review and meta-analysis. JAMA Neurol, 2015, 72(4): 432-440.
7.	Cole JC, Green Bernacki C, Helmer A, et al. Efficacy of transcranial magnetic stimulation (TMS) in the treatment of schizophrenia: a review of the literature to date. Innov Clin Neuro, 2015, 12(7/8): 12-19.
8.	Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety, 2012, 29(7): 587-596.
9.	李娜, 何亮亮, 王小平, 等. 重復經顱磁刺激治療原發性三叉神經痛的療效及安全性分析. 中國全科醫學, 2016, 19(12): 1387-1391.
10.	Tian SQ, Nick S, Wu H. Phantom limb pain: a review of evidencebased treatment options. World J Anesthesiol, 2014, 3(2): 146-153.
11.	Tazoe T, Perez MA. Effects of repetitive transcranial magnetic stimulation on recovery of function after spinal cord injury. Arch Phys Med Rehabil, 2015, 96(4 Suppl): S145-S155.
12.	Knikou M. Plasticity of corticospinal neural control after locomotor training in human spinal cord injury. Neural Plast, 2012, 2012: 254948.
13.	Saturno E, Bonato C, Miniussi C, et al. Motor cortex changes in spinal cord injury: a TMS study. Neurol Res, 2008, 30(10): 1084-1085.
14.	Lotze M, Laubis-Herrmann U, Topka H. Combination of TMS and fMRI reveals a specific pattern of reorganization in M1 in patients after complete spinal cord injury. Restor Neurol Neurosci, 2006, 24(2): 97-107.
15.	Turner JA, Lee JS, Martinez O, et al. Somatotopy of the motor cortex after long-term spinal cord injury or amputation. IEEE Trans Neural Syst Rehabil Eng, 2001, 9(2): 154-160.
16.	Bruehlmeier M, Dietz V, Leenders KL, et al. How does the human brain deal with a spinal cord injury?. Eur J Neurosci, 1998, 10(12): 3918-3922.
17.	Freund P, Weiskopf N, Ashburner J, et al. MRI investigation of the sensorimotor cortex and the corticospinal tract after acute spinal cord injury: a prospective longitudinal study. The Lancet Neurol, 2013, 12(9): 873-881.
18.	Davey NJ, Smith HC, Wells E, et al. Responses of thenar muscles to transcranial magnetic stimulation of the motor cortex in patients with incomplete spinal cord injury. J Neurol Neurosurg Psychiatry, 1998, 65(1): 80-87.
19.	Ridding MC, Ziemann U. Determinants of the induction of cortical plasticity by non-invasive brain stimulation in healthy subjects. J Physiol, 2010, 588(Pt 13): 2291-2304.
20.	Belci M, Catley M, Husain M, et al. Magnetic brain stimulation can improve clinical outcome in incomplete spinal cord injured patients. Spinal Cord, 2004, 42(7): 417-419.
21.	Filli L, Schwab ME. Structural and functional reorganization of propriospinal connections promotes functional recovery after spinal cord injury. Neural Regen Res, 2015, 10(4): 509-513.
22.	葉超群, 孫天勝, 劉智. 脊髓損傷后軸突再生的研究進展. 中國脊柱脊髓雜志, 2007, 17(9): 715-718.
23.	張新, 李建軍, 霍小林, 等. 重復經顱磁刺激對脊髓運動功能恢復的影響及其機制的實驗研究. 中國康復理論與實踐, 2008, 14(3): 228-230.
24.	Saruhashi Y, Young W, Perkins R. The recovery of 5-HT immunoreactivity in lumbosacral spinal cord and locomotor function after thoracic hemisection. Exp Neurol, 1996, 139(2): 203-213.
25.	吳衛衛, 黃國志. 重復經顱磁刺激對脊髓損傷大鼠運動功能的影響. 中國康復醫學雜志, 2011, 26(3): 215-220.
26.	Gao W, Yu LG, Liu YL, et al. Mechanism of GABA receptors involved in spasticity inhibition induced by transcranial magnetic stimulation following spinal cord injury. J Huazhong Univ Sci Technolog Med Sci, 2015, 35(2): 241-247.
27.	Moreno-Duarte I, Morse LR, Alam M, et al. Targeted therapies using electrical and magnetic neural stimulation for the treatment of chronic pain in spinal cord injury. Neuroimage, 2014, 85(Pt 3): 1003-1013.
28.	Pascoal-Faria P, Yalcin N, Fregni F. Neural markers of neuropathic pain associated with maladaptive plasticity in spinal cord injury. Pain Pract, 2015, 15(4): 371-377.
29.	Defrin R, Grunhaus L, Zamir D, et al. The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury. Arch Phys Med Rehabil, 2007, 88(12): 1574-1580.
30.	Kang BS, Shin HI, Bang MS. Effect of repetitive transcranial magnetic stimulation over the hand motor cortical area on central pain after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(10): 1766-1771.
31.	Jetté F, C?té I, Meziane HB, et al. Effect of single-session repetitive transcranial magnetic stimulation applied over the hand <italic>versus</italic> leg motor area on pain after spinal cord injury. Neurorehabil Neural Repair, 2013, 27(7): 636-643.
32.	Yilmaz B, Kesikburun S, Ya?ar E, et al. The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury. J Spinal Cord Med, 2014, 37(4): 397-400.
33.	Nardone R, H?ller Y, Langthaler PB, et al. rTMS of the prefrontal cortex has analgesic effects on neuropathic pain in subjects with spinal cord injury. Spinal Cord, 2017, 55(1): 20-25.
34.	白金柱, 洪毅, 關驊, 等. 經顱磁刺激同步踏車訓練在胸腰段脊髓損傷治療中的應用. 中國脊柱脊髓雜志, 2010, 20(9): 707-710.
35.	潘鈺, 汪漩, 杜巨豹, 等. 重復經顱磁刺激對不完全性脊髓損傷患者的干預效果. 中國康復理論與實踐, 2009, 15(11): 1058-1060.
36.	潘鈺, 郄淑燕, 劉暢, 等. 重復經顱磁刺激對不完全性脊髓損傷患者運動和步行功能的療效. 中國康復理論與實踐, 2013, 19(7): 662-665.
37.	Benito J, Kumru H, Murillo N, et al. Motor and gait improvement in patients with incomplete spinal cord injury induced by high-frequency repetitive transcranial magnetic stimulation. Top Spinal Cord Inj Rehabil, 2012, 18(2): 106-112.
38.	Gazzaniga MS, Ivry RB, Mangun GR. Cognitive neuroscience the biology of the mind. 3rd ed. Beijing: China Light Industry Press, 2011: 223-269.
39.	Gomes-Osman J, Field-Fote EC. Improvements in hand function in adults with chronic tetraplegia following a multiday 10-Hz repetitive transcranial magnetic stimulation intervention combined with repetitive task practice. J Neurol Phys Ther, 2015, 39(1): 23-30.
40.	Kuppuswamy A, Balasubramaniam AV, Maksimovic R, et al. Action of 5 Hz repetitive transcranial magnetic stimulation on sensory, motor and autonomic function in human spinal cord injury. Clin Neurophysiol, 2011, 122(12): 2452-2461.
41.	Baunsgaard CB, Nissen UV, Christensen KB, et al. Modified ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation. Spinal Cord, 2016, 54(9): 702-708.
42.	Kumru H, Murillo N, Samso JV, et al. Reduction of spasticity with repetitive transcranial magnetic stimulation in patients with spinal cord injury. Neurorehabil Neural Repair, 2010, 24(5): 435-441.
43.	Ziemann U. Pharmacology of TMS. Suppl Clin Neurophysiol, 2003, 56: 226-231.
44.	Nardone R, H?ller Y, Thomschewski A, et al. rTMS modulates reciprocal inhibition in patients with traumatic spinal cord injury. Spinal Cord, 2014, 52(11): 831-835.
45.	Biering-S?rensen F, Nielsen JB, Klinge K. Spasticity-assessment: a review. Spinal Cord, 2006, 44(12): 708-722.
46.	Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol, 2009, 120(12): 2008-2039.

1. Kobayashi M, Pascual-Leone A. Transcranial magnetic stimulation in neurology. Lancet Neurol, 2003, 2(3): 145-156.
2. 李江濤, 鄭敏軍, 曹輝, 等. 經顱磁刺激技術的研究進展. 高電壓技術, 2016, 42(4): 1168-1178.
3. Pinter MM, Brainin M. Role of repetitive transcranial magnetic stimulation in stroke rehabilitation. Front Neurol Neurosci, 2013, 32: 112-121.
4. 王樸, 張嘉祺, 余佳丹, 等. 重復經顱磁刺激治療腦卒中患者失語癥效果的系統評價. 中國循證醫學雜志, 2014, 14(12): 1497-1503.
5. Liao X, Xing G, Guo Z, et al. Repetitive transcranial magnetic stimulation as an alternative therapy for dysphagia after stroke: a systematic review and meta-analysis. Clin Rehabil, 2017, 31(3): 289-298.
6. Chou YH, Hickey PT, Sundman M, et al. Effects of repetitive transcranial magnetic stimulation on motor symptoms in Parkinson disease: a systematic review and meta-analysis. JAMA Neurol, 2015, 72(4): 432-440.
7. Cole JC, Green Bernacki C, Helmer A, et al. Efficacy of transcranial magnetic stimulation (TMS) in the treatment of schizophrenia: a review of the literature to date. Innov Clin Neuro, 2015, 12(7/8): 12-19.
8. Carpenter LL, Janicak PG, Aaronson ST, et al. Transcranial magnetic stimulation (TMS) for major depression: a multisite, naturalistic, observational study of acute treatment outcomes in clinical practice. Depress Anxiety, 2012, 29(7): 587-596.
9. 李娜, 何亮亮, 王小平, 等. 重復經顱磁刺激治療原發性三叉神經痛的療效及安全性分析. 中國全科醫學, 2016, 19(12): 1387-1391.
10. Tian SQ, Nick S, Wu H. Phantom limb pain: a review of evidencebased treatment options. World J Anesthesiol, 2014, 3(2): 146-153.
11. Tazoe T, Perez MA. Effects of repetitive transcranial magnetic stimulation on recovery of function after spinal cord injury. Arch Phys Med Rehabil, 2015, 96(4 Suppl): S145-S155.
12. Knikou M. Plasticity of corticospinal neural control after locomotor training in human spinal cord injury. Neural Plast, 2012, 2012: 254948.
13. Saturno E, Bonato C, Miniussi C, et al. Motor cortex changes in spinal cord injury: a TMS study. Neurol Res, 2008, 30(10): 1084-1085.
14. Lotze M, Laubis-Herrmann U, Topka H. Combination of TMS and fMRI reveals a specific pattern of reorganization in M1 in patients after complete spinal cord injury. Restor Neurol Neurosci, 2006, 24(2): 97-107.
15. Turner JA, Lee JS, Martinez O, et al. Somatotopy of the motor cortex after long-term spinal cord injury or amputation. IEEE Trans Neural Syst Rehabil Eng, 2001, 9(2): 154-160.
16. Bruehlmeier M, Dietz V, Leenders KL, et al. How does the human brain deal with a spinal cord injury?. Eur J Neurosci, 1998, 10(12): 3918-3922.
17. Freund P, Weiskopf N, Ashburner J, et al. MRI investigation of the sensorimotor cortex and the corticospinal tract after acute spinal cord injury: a prospective longitudinal study. The Lancet Neurol, 2013, 12(9): 873-881.
18. Davey NJ, Smith HC, Wells E, et al. Responses of thenar muscles to transcranial magnetic stimulation of the motor cortex in patients with incomplete spinal cord injury. J Neurol Neurosurg Psychiatry, 1998, 65(1): 80-87.
19. Ridding MC, Ziemann U. Determinants of the induction of cortical plasticity by non-invasive brain stimulation in healthy subjects. J Physiol, 2010, 588(Pt 13): 2291-2304.
20. Belci M, Catley M, Husain M, et al. Magnetic brain stimulation can improve clinical outcome in incomplete spinal cord injured patients. Spinal Cord, 2004, 42(7): 417-419.
21. Filli L, Schwab ME. Structural and functional reorganization of propriospinal connections promotes functional recovery after spinal cord injury. Neural Regen Res, 2015, 10(4): 509-513.
22. 葉超群, 孫天勝, 劉智. 脊髓損傷后軸突再生的研究進展. 中國脊柱脊髓雜志, 2007, 17(9): 715-718.
23. 張新, 李建軍, 霍小林, 等. 重復經顱磁刺激對脊髓運動功能恢復的影響及其機制的實驗研究. 中國康復理論與實踐, 2008, 14(3): 228-230.
24. Saruhashi Y, Young W, Perkins R. The recovery of 5-HT immunoreactivity in lumbosacral spinal cord and locomotor function after thoracic hemisection. Exp Neurol, 1996, 139(2): 203-213.
25. 吳衛衛, 黃國志. 重復經顱磁刺激對脊髓損傷大鼠運動功能的影響. 中國康復醫學雜志, 2011, 26(3): 215-220.
26. Gao W, Yu LG, Liu YL, et al. Mechanism of GABA receptors involved in spasticity inhibition induced by transcranial magnetic stimulation following spinal cord injury. J Huazhong Univ Sci Technolog Med Sci, 2015, 35(2): 241-247.
27. Moreno-Duarte I, Morse LR, Alam M, et al. Targeted therapies using electrical and magnetic neural stimulation for the treatment of chronic pain in spinal cord injury. Neuroimage, 2014, 85(Pt 3): 1003-1013.
28. Pascoal-Faria P, Yalcin N, Fregni F. Neural markers of neuropathic pain associated with maladaptive plasticity in spinal cord injury. Pain Pract, 2015, 15(4): 371-377.
29. Defrin R, Grunhaus L, Zamir D, et al. The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury. Arch Phys Med Rehabil, 2007, 88(12): 1574-1580.
30. Kang BS, Shin HI, Bang MS. Effect of repetitive transcranial magnetic stimulation over the hand motor cortical area on central pain after spinal cord injury. Arch Phys Med Rehabil, 2009, 90(10): 1766-1771.
31. Jetté F, C?té I, Meziane HB, et al. Effect of single-session repetitive transcranial magnetic stimulation applied over the hand <italic>versus</italic> leg motor area on pain after spinal cord injury. Neurorehabil Neural Repair, 2013, 27(7): 636-643.
32. Yilmaz B, Kesikburun S, Ya?ar E, et al. The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury. J Spinal Cord Med, 2014, 37(4): 397-400.
33. Nardone R, H?ller Y, Langthaler PB, et al. rTMS of the prefrontal cortex has analgesic effects on neuropathic pain in subjects with spinal cord injury. Spinal Cord, 2017, 55(1): 20-25.
34. 白金柱, 洪毅, 關驊, 等. 經顱磁刺激同步踏車訓練在胸腰段脊髓損傷治療中的應用. 中國脊柱脊髓雜志, 2010, 20(9): 707-710.
35. 潘鈺, 汪漩, 杜巨豹, 等. 重復經顱磁刺激對不完全性脊髓損傷患者的干預效果. 中國康復理論與實踐, 2009, 15(11): 1058-1060.
36. 潘鈺, 郄淑燕, 劉暢, 等. 重復經顱磁刺激對不完全性脊髓損傷患者運動和步行功能的療效. 中國康復理論與實踐, 2013, 19(7): 662-665.
37. Benito J, Kumru H, Murillo N, et al. Motor and gait improvement in patients with incomplete spinal cord injury induced by high-frequency repetitive transcranial magnetic stimulation. Top Spinal Cord Inj Rehabil, 2012, 18(2): 106-112.
38. Gazzaniga MS, Ivry RB, Mangun GR. Cognitive neuroscience the biology of the mind. 3rd ed. Beijing: China Light Industry Press, 2011: 223-269.
39. Gomes-Osman J, Field-Fote EC. Improvements in hand function in adults with chronic tetraplegia following a multiday 10-Hz repetitive transcranial magnetic stimulation intervention combined with repetitive task practice. J Neurol Phys Ther, 2015, 39(1): 23-30.
40. Kuppuswamy A, Balasubramaniam AV, Maksimovic R, et al. Action of 5 Hz repetitive transcranial magnetic stimulation on sensory, motor and autonomic function in human spinal cord injury. Clin Neurophysiol, 2011, 122(12): 2452-2461.
41. Baunsgaard CB, Nissen UV, Christensen KB, et al. Modified ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation. Spinal Cord, 2016, 54(9): 702-708.
42. Kumru H, Murillo N, Samso JV, et al. Reduction of spasticity with repetitive transcranial magnetic stimulation in patients with spinal cord injury. Neurorehabil Neural Repair, 2010, 24(5): 435-441.
43. Ziemann U. Pharmacology of TMS. Suppl Clin Neurophysiol, 2003, 56: 226-231.
44. Nardone R, H?ller Y, Thomschewski A, et al. rTMS modulates reciprocal inhibition in patients with traumatic spinal cord injury. Spinal Cord, 2014, 52(11): 831-835.
45. Biering-S?rensen F, Nielsen JB, Klinge K. Spasticity-assessment: a review. Spinal Cord, 2006, 44(12): 708-722.
46. Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol, 2009, 120(12): 2008-2039.

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重復性經顱磁刺激用于脊髓損傷康復的研究進展

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