经颅磁刺激技术在脊髓损伤后痉挛中的应用机制进展

doi:10.3969/j.issn.1006-9771.2019.06.005

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (6): 644-647.doi: 10.3969/j.issn.1006-9771.2019.06.005

经颅磁刺激技术在脊髓损伤后痉挛中的应用机制进展

贾晋瑄, 吴毅

复旦大学附属华山医院康复医学科，上海市 200040

收稿日期:2018-11-12 修回日期:2019-01-27 发布日期:2019-06-25
通讯作者: 吴毅，E-mail: wuyi@fudan.edu.cn
作者简介:贾晋瑄(1991-)，女，汉族，台湾桃园市人，博士，医师，主要研究方向：神经康复、神经电生理评定技术。
基金资助:
1. 上海市卫计委重要薄弱学科建设项目(No. 2015ZB0401)；2. 上海市科学技术委员会项目(No. 17411953900)

Advance in Transcranial Magnetic Stimulation for Spasticity post Spinal Cord Injury (review)

Chin-hsuan CHIA, WU Yi

Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China

Received:2018-11-12 Revised:2019-01-27 Online:2019-06-25
Contact: WU Yi, E-mail: wuyi@fudan.edu.cn
Supported by:
Supported by Shanghai Health and Family Planning Committee Key Weak Discipline Construction Project (No. 2015ZB0401) and Shanghai Science and Technology Committee Project (No. 17411953900)

摘要/Abstract

摘要： 痉挛状态为脊髓损伤的常见症状，痉挛的机制可概括为由于脊髓下行抑制性冲动的消失导致梭内肌与梭外肌形成的反馈及前馈环路的平衡发生改变，导致痉挛状态。经颅磁刺激(TMS)可能通过增加中枢抑制性中间神经元的兴奋性，抑制脊髓水平的兴奋性，从而达到控制痉挛状态的效果。本文主要针对脊髓损伤后痉挛状态进行讨论，对其发病机制及TMS应用于脊髓损伤后痉挛状态的概况和作用机制进行综述。

关键词: 脊髓损伤, 痉挛状态, 经颅磁刺激, 综述

Abstract: Spasticity is one of the common symptoms in patients with spinal cord injury, the mechanism can be summarized that the disappearance of the inhibition signals of descending pass of the spinal cord lead to the change of the balance between the circuit of the feedback and feedforward formed by the intra spindle muscle and extra spindle muscle, and the spasticity appear. Transcranial magnetic stimulation (TMS) can release the spasticity through increasing the excitability of the inhibitory interneurons to decrease the excitability of the spinal level. This article discussed about the mechanism of the spasticity after spinal cord injury first and then summarized the application and the therapeutic theory of the TMS on it.

Key words: spinal cord injury, spasticity, transcranial magnetic stimulation, review

中图分类号:

R651.2

贾晋瑄, 吴毅. 经颅磁刺激技术在脊髓损伤后痉挛中的应用机制进展[J]. 《中国康复理论与实践》, 2019, 25(6): 644-647.

Chin-hsuan CHIA, WU Yi. Advance in Transcranial Magnetic Stimulation for Spasticity post Spinal Cord Injury (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(6): 644-647.

参考文献

1 SminkeyL. Spinal cord injury [EB/OL]. (2013-12-02) [2016/10/13]. www.who.int/mediacentre/news/releases/2013/spinal-cord-injury-20131202/en/.
2 TazoeT, PerezM A. Effects of repetitive transcranial magnetic stimulation on recovery of function after spinal cord injury [J]. Arch Phys Med Rehabil, 2015, 96(4): S145-S155.
3 MukherjeeA, ChakravartyA. Spasticity Mechanisms: for the Clinician [J]. Front Neurol, 2010, 1(49): 1-10.
4 SköldC, LeviR, SeigerA. Spasticity after traumatic spinal cord injury: nature, severity, and location [J]. Arch Phys Med Rehabil, 1999, 80(12): 1548-1557.
5 MaynardF M, KarunasR S. Epidemiology of spasticity following traumatic spinal cord injury [J]. Arch Phys Med Rehabil, 1990, 71(8): 559-566.
6 DitunnoJ F, LittleJ W, TesslerA, et al. Spinal shock revisited: a four-phase model [J]. Spinal Cord, 2004, 42(7): 383-395.
7 AshbyP, VerrierM, LightfootE. Segmental reflex pathways in spinal shock and spinal spasticity in man [J]. J Neurol Neurosurg Psychiatry, 1974, 37(12): 1352-1360.
8 HiersemenzelL P, CurtA, DietzV. From spinal shock to spasticity neuronal adaptations to a spinal cord injury [J]. Neurology, 2000, 54(8): 1574-1582.
9 LiY, BennettD J. Persistent sodium and calcium currents cause plateau potentials in motoneurons of chronic spinal rats [J]. J Neurophysiol, 2003, 90(2): 857-869.
10 HeckmanC J, GorassiniM A, BennettD J. Persistent inward currents in motoneuron dendrites: implications for motor output [J]. Mucscle Nerve, 2005, 31(2): 135-156.
11 LiY, GorassiniM A, BennettD J. Role of persistent sodium and calcium currents in motoneuron firing and spasticity in chronic spinal rats [J]. J Neurophysiol, 2004, 91(2): 767-783.
12 MoritzA T, NewkirkG, PowersR K, et al. Facilitation of somatic calcium channels can evoke prolonged tail currents in rat hypoglossal motoneurons [J]. J Neurophysiol, 2007, 98(2): 1042-1047.
13 RudominP, SchmidtR F. Presynaptic inhibition in the vertebrate spinal cord revisited [J]. Exp Brain Res, 1999, 129(1): 1-37.
14 MailisA, AshbyP. Alterations in group Ia projections to motoneurons following spinal lesions in humans [J]. J Neurophysiol, 1990, 64(2): 637-647.
15 ShahaniB T, YoungR R. The flexor reflex in spasticity [D]. Chicago: Yearbook Medical Publishers, 1980.
16 RankM M, MurrayK C, StephensM J, et al. Adrenergic receptors modulate motoneuron excitability, sensory synaptic transmission and muscle spasms after chronic spinal cord injury [J]. J Neurophysiol, 2011, 105(1): 410-422.
17 Biering-SorensenB, KristensenI B, KjaerM, et al. Muscle after spinal cord injury [J]. Muscle Nerve, 2009, 40(4): 499-519.
18 ScelsiR, MarchettiC, PoggiP, et al. Muscle fiber type morphology and distribution in paraplegic patients with traumatic cord lesion. Histochemical and ultrastructural aspects of rectus femoris muscle [J]. Acta Neuropathol, 1982, 57(4): 243-248.
19 NielsenJ B, CroneC, HultbornH. The spinal pathophysiology of spasticity? From a basic science point of view [J]. Acta Physiol (Oxf), 2007, 189(2): 171-180.
20 LittleJ W, MicklessenP, UmlaufR, et al. Lower extremity manifestations of spasticity in chronic spinal cord injury [J]. Am J Phys Med Rehabil, 1989, 68(1): 32-36.
21 Beres-JonesJ A, JohnsonT D, HarkemaS J. Clonus after human spinal cord injury cannot be attributed solely to recurrent muscle-tendon stretch [J]. Exp Brain Res, 2003, 149(2): 222-236.
22 SchmitB D, BenzE N, RymerW Z. Reflex mechanisms for motor impairment in spinal cord injury [J]. Adv Exp Med Biol, 2002, 508(NA): 315-323.
23 D'AmicoJ M, CondliffeE G, MartinsK J B, et al. Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity [J]. Front Integr Neurosci, 2014, 8(36): 1-24.
24 ElbasiounyS M, MorozD, BakrM M, et al. Management of spasticity after spinal cord injury: current techniques and future directions [J]. Neurorehabil Neural Repair, 2010, 24(1): 23-33.
25 BarkerA T, JalinousR, FreestonI L. Non-invasive magnetic stimulation of human motor cortex [J]. Lancet, 1985, 325(8437): 1106-1107.
26 ChervyakovA V, ChernyavskyA Y, SinitsynD O, et al. Possible mechanisms underlying the therapeutic effects of transcranial magnetic stimulation [J]. Front Hum Neurosci, 2015, 9(303): 1-14.
27 KobayashiM, PascualleoneA. Transcranial magnetic stimulation in neurology [J]. Lancet Neurol, 2003, 2(3): 145-156.
28 BenitoJ, KumruH, MurlloN. Motor and gait improvement in patients with incomplete spinal cord injury induced by highfrequency repetitive transcranial magnetic stimulation [J]. Top Spinal Cord Inj Rehabil, 2012, 18(2): 106-112.
29 KumruH, MurilloN, Vidal SamsoJ, et al. Reduction of spasticity with repetitive transcranial magnetic stimulation in patients with spinal cord injury [J]. Neurorehabil Neural Repair, 2010, 24(5): 435-441.
30 MoriF, CodecàC, KusayanagiH, et al. Effects of intermittent theta burst stimulation on spasticity in patients with multiple sclerosis [J]. Eur J Neurol, 2010, 17(2): 295-300.
31 HuangY, EdwardsM J, RounisE, et al. Theta burst stimulation of the human motor cortex [J]. Neuron, 2005, 45(2): 201-206.
32 Di LazzaroV, PilatoF, DileoneM, et al. The physiological basis of the effects of intermittent theta burst stimulation of the human motor cortex [J]. J Physiol, 2008, 586(16): 3871-3879.
33 NardoneR, LlerY H, ThomschewskiA, et al. rTMS modulates reciprocal inhibition in patients with traumatic spinal cord injury [J]. Spinal Cord, 2014, 52(11): 831-835.
34 KorzhovaJ, SinitsynD, ChervyakovA, et al. Transcranial and spinal cord magnetic stimulation in treatment of spasticity. A literature review and meta-analysis [J]. Eur J Phys Rehabil Med, 2016, 54(1): 1-29.
35 NardoneR, HöllerY, BrigoF, et al. Descending motor pathways and cortical physiology after spinal cord injury assessed by transcranial magnetic stimulation: a systematic review [J]. Brain Res, 2015, 1619: 139-154.
36 KimD H, ShinJ C, JungS, et al. Effects of intermittent theta burst stimulation on spasticity after stroke [J]. Neuroreport, 2015, 26(10): 561-566.

[1]	邵伟婷, 雷江华. 反应中断再定向干预孤独症谱系障碍儿童刻板语言的效果：Scoping综述[J]. 《中国康复理论与实践》, 2024, 30(1): 10-20.
[2]	王航宇, 葛可可, 范永红, 都丽露, 邹敏, 封磊. 基于ICD-11和ICF主动式音乐疗法改善认知障碍老年人认知功能的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 36-43.
[3]	闻嘉宁, 金秋艳, 张琦, 李杰, 司琦. 认知参与型身体活动对发展儿童青少年执行功能的效果：基于ICF的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 44-53.
[4]	葛可可, 范永红, 王航宇, 都丽露, 李长江, 邹敏. 失眠老年人正念干预健康效益的系统综述[J]. 《中国康复理论与实践》, 2024, 30(1): 54-60.
[5]	刘冬, 徐子涵, 李江, 鞠萍. M1区联合背外侧前额叶高频重复经颅磁刺激对脊髓损伤后神经病理性疼痛患者脑电图θ振幅的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 87-94.
[6]	张婧雅, 邹敏, 孙宏伟, 孙昌隆, 朱峻同. 听障儿童青少年焦虑或抑郁情绪心理干预效果的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1004-1011.
[7]	王俊宇, 杨永, 袁逊, 谢婷, 庄洁. 高强度间歇训练对健康儿童青少年执行功能效果的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1012-1020.
[8]	魏晓微, 杨剑, 魏春艳. 特殊教育学校孤独症谱系障碍儿童参与适应性瑜伽活动的心理与行为效益的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1021-1028.
[9]	杨亚茹, 杨剑. 基于WHO-HPS架构学校身体活动相关健康服务及其健康效益：系统综述的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1040-1047.
[10]	史佳伟, 李凌宇, 杨浩杰, 王琴潞, 邹海欧. 预康复对全膝关节置换术后患者的有效性：系统综述的系统综述[J]. 《中国康复理论与实践》, 2023, 29(9): 1057-1064.
[11]	蒋长好, 黄辰, 高晓妍, 戴元富, 赵国明. 神经反馈训练对老年人认知功能效果的系统综述[J]. 《中国康复理论与实践》, 2023, 29(8): 903-909.
[12]	魏晓微, 杨剑, 魏春艳, 贺启令. 学校环境下适应性体育课程促进智力与发展性残疾儿童心理运动发展的系统综述[J]. 《中国康复理论与实践》, 2023, 29(8): 910-918.
[13]	陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.
[14]	蒙象强, 熊琪, 陈庚发, 白洋, 邹田子, 冯珍. 经颅磁刺激联合正中神经电刺激干预不同年龄段慢性意识障碍的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 940-947.
[15]	李芳, 霍速, 杜巨豹, 刘秀贞, 李小爽, 宋为群. 经颅直流电刺激联合任务导向性康复训练对脊髓损伤大鼠前肢运动障碍的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 777-781.

经颅磁刺激技术在脊髓损伤后痉挛中的应用机制进展

Advance in Transcranial Magnetic Stimulation for Spasticity post Spinal Cord Injury (review)

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0