Shulga Anastasia, Lioumis Pantelis, Zubareva Aleksandra, Brandstack Nina, Kuusela Linda, Kirveskari Erika, Savolainen Sarianna, Ylinen Aarne, Mäkelä Jyrki P
Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital , Helsinki, Finland.
Spinal Cord Ser Cases. 2016 Jul 14;2:16016. doi: 10.1038/scsandc.2016.16. eCollection 2016.
Emerging therapeutic strategies for spinal cord injury aim at sparing or restoring at least part of the corticospinal tract at the acute stage. Hence, approaches that strengthen the weak connections that are spared or restored are crucial. Transient plastic changes in the human corticospinal tract can be induced through paired associative stimulation, a noninvasive technique in which transcranial magnetic brain stimulation is synchronized with electrical peripheral nerve stimulation. A single paired associative stimulation session can induce transient plasticity in spinal cord injury patients. It is not known whether paired associative stimulation can strengthen neuronal connections persistently and have therapeutic effects that are clinically relevant. We recruited two patients with motor-incomplete chronic (one para- and one tetraplegic) spinal cord injuries. The patients received paired associative stimulation for 20-24 weeks. The paraplegic patient, previously paralyzed below the knee level, regained plantarflexion and dorsiflexion of the ankles of both legs. The tetraplegic patient regained grasping ability. The newly acquired voluntary movements could be performed by the patients in the absence of stimulation and for at least 1 month after the last stimulation session. In this unblinded proof-of-principle demonstration in two subjects, long-term paired associative stimulation induced persistent and clinically relevant strengthening of neural connections and restored voluntary movement in previously paralyzed muscles. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.
脊髓损伤的新兴治疗策略旨在在急性期保留或恢复至少部分皮质脊髓束。因此，加强那些得以保留或恢复的薄弱连接的方法至关重要。通过配对联想刺激可以诱导人类皮质脊髓束发生短暂的可塑性变化，这是一种非侵入性技术，其中经颅磁脑刺激与外周神经电刺激同步。单次配对联想刺激可在脊髓损伤患者中诱导短暂的可塑性。尚不清楚配对联想刺激是否能持续加强神经元连接并产生具有临床相关性的治疗效果。我们招募了两名运动不完全性慢性脊髓损伤患者（一名截瘫患者和一名四肢瘫患者）。这两名患者接受了20 - 24周的配对联想刺激。截瘫患者此前膝盖以下瘫痪，现已恢复双腿脚踝的跖屈和背屈功能。四肢瘫患者恢复了抓握能力。患者在无刺激的情况下以及在最后一次刺激疗程后至少1个月内都能进行新获得的自主运动。在这个针对两名受试者的非盲法原理验证演示中，长期配对联想刺激诱导了神经连接的持续且具有临床相关性的增强，并恢复了先前瘫痪肌肉的自主运动。需要进一步研究以确认长期配对联想刺激本身是否可用于脊髓损伤后的康复，以及是否可能与其他治疗策略联合使用。
