Baylor College of Medicine, Division of Restorative Neurology and Human Neurobiology, I Baylor Plaza, Room S-800, Houston, TX, USA.
Restor Neurol Neurosci. 1995 Jan 1;7(4):225-34. doi: 10.3233/RNN-1994-7405.
Introduction of transcranial magnetic stimulation (TMS) has provided means to study non-invasively corticospinal functions in humans. The purpose of the present study was to obtain an objective evaluation of spinal cord functions in spinal cord injury (SCI) subjects using TMS, multichannel surface EMG and somatosensory-evoked potentials (SSEP). Multichannel surface EMG recording was performed during reinforcement manoeuvres and during vibratory tonic reflex. Twenty-five post-traumatic clinically incomplete (ambulatory, AMB, and non-ambulatory, nAMB) SCI subjects were studied and compared to a control group of seven subjects. After preliminary analysis of neurophysiological studies they were divided into four groups according to presence or absence of motor-evoked potentials (MEP) in response to TMS in muscles below the level of the lesion and according to their ability to ambulate. TMS was delivered at vertex at 100% intensity and recorded from the large muscles of the upper and lower limbs. Surface EMG was recorded during reinforcement manoeuvres (RM) in the leg muscles and EMG activity was scored. SSEP were recorded at T12, L2, L4 and SI spinous processes and at Cz' on the scalp following tibial nerve stimulation at popliteal fossa. The prevalence of EMG responses during RM was higher in group with present MEPs (AMB/MEP+ and nAMB/MEP+) than in the group without MEPs. The group with present MEPs also showed better preserved functions of the ascending tracts compared to subjects without MEPs. Groups with present MEPs had 5/10 normal, 2/10 abnormal and 3/10 absent cortical SSEPs, whereas groups without MEPs showed 1/11 normal, 4/11 abnormal and 6/11 absent cortical SSEPs. Sustained function of ascending tracts was also positively correlated with preserved ability to ambulate. It was concluded that TMS in combination with multichannel surface EMG monitoring and sensory evoked potentials may prove feasible in assessing the functional capacity of the spinal cord after spinal cord lesion.
经颅磁刺激（TMS）的引入为研究人类皮质脊髓功能提供了一种非侵入性手段。本研究的目的是使用 TMS、多通道表面肌电图和体感诱发电位（SSEP）对脊髓损伤（SCI）患者的脊髓功能进行客观评估。在强化动作和振动紧张反射期间进行多通道表面肌电图记录。研究了 25 名创伤后临床不完全性（可走动的 AMB 和不可走动的 nAMB）SCI 患者，并与 7 名对照组患者进行了比较。在对神经生理学研究进行初步分析后，根据 TMS 刺激下肌肉中运动诱发电位（MEP）的存在或不存在以及他们走动的能力，将他们分为四组。TMS 在顶点以 100%的强度传递，并从上下肢的大肌肉记录。在腿部肌肉的强化动作期间记录表面肌电图（RM），并对肌电图活动进行评分。在 T12、L2、L4 和 SI 棘突以及头皮上的 Cz'记录胫后神经刺激时的 SSEP。在有 MEP 的组（AMB/MEP+和 nAMB/MEP+）中，RM 期间出现肌电图反应的比例高于无 MEP 的组。与无 MEP 的患者相比，有 MEP 的患者的上行束功能也更好地保存。有 MEP 的组中有 5/10 个正常、2/10 个异常和 3/10 个缺失皮质 SSEP，而无 MEP 的组中有 1/11 个正常、4/11 个异常和 6/11 个缺失皮质 SSEP。上行束的持续功能也与保持走动能力呈正相关。结论：TMS 与多通道表面肌电图监测和感觉诱发电位相结合，可能在评估脊髓损伤后脊髓的功能能力方面是可行的。
