Fassett Hunter J, Turco Claudia V, El-Sayes Jenin, Lulic Tea, Baker Steve, Richardson Brian, Nelson Aimee J
Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
Division of Physical Medicine and Rehabilitation, Department of Medicine, McMaster University, Hamilton, ON, Canada.
Front Neurol. 2017 Aug 4;8:380. doi: 10.3389/fneur.2017.00380. eCollection 2017.
Intermittent theta burst stimulation (iTBS) is intended primarily to alter corticospinal excitability, creating an attractive opportunity to alter neural output following incomplete spinal cord injury (SCI). This study is the first to assess the effects of iTBS in SCI. Eight individuals with chronic incomplete SCI were studied. Sham or real iTBS was delivered (to each participant) over primary motor and somatosensory cortices in separate sessions. Motor-evoked potential (MEP) recruitment curves were obtained from the flexor carpi radialis muscle before and after iTBS. Results indicate similar responses for iTBS to both motor and somatosensory cortex and reduced MEPs in 56.25% and increased MEPs in 25% of instances. Sham stimulation exceeded real iTBS effects in the remaining 18.25%. It is our opinion that observing short-term neuroplasticity in corticospinal output in chronic SCI is an important advance and should be tested in future studies as an opportunity to improve function in this population. We emphasize the need to re-consider the importance of the direction of MEP change following a single session of iTBS since the relationship between MEP direction and motor function is unknown and multiple sessions of iTBS may yield very different directional results. Furthermore, we highlight the importance of including sham control in the experimental design. The fundamental point from this pilot research is that a single session of iTBS is often capable of creating short-term change in SCI. Future sham-controlled randomized trials may consider repeat iTBS sessions to promote long-term changes in corticospinal excitability.
间歇性θ波爆发刺激（iTBS）主要旨在改变皮质脊髓兴奋性，为脊髓损伤（SCI）不完全损伤后改变神经输出创造了一个有吸引力的机会。本研究首次评估了iTBS对SCI的影响。研究了8名慢性SCI不完全损伤患者。在单独的疗程中，对每位参与者的初级运动皮质和躯体感觉皮质进行假刺激或真实iTBS刺激。在iTBS刺激前后，从桡侧腕屈肌获取运动诱发电位（MEP）募集曲线。结果表明，iTBS对运动皮质和躯体感觉皮质的反应相似，56.25%的情况下MEP降低，25%的情况下MEP升高。在其余18.25%的情况下，假刺激的效果超过了真实iTBS。我们认为，观察慢性SCI中皮质脊髓输出的短期神经可塑性是一项重要进展，应在未来研究中作为改善该人群功能的一个机会进行测试。我们强调，由于MEP方向与运动功能之间的关系尚不清楚，且多次iTBS刺激可能会产生非常不同的方向结果，因此需要重新考虑单次iTBS刺激后MEP变化方向的重要性。此外，我们强调了在实验设计中纳入假刺激对照的重要性。这项初步研究的基本要点是，单次iTBS刺激通常能够在SCI中产生短期变化。未来的假刺激对照随机试验可能会考虑重复进行iTBS刺激，以促进皮质脊髓兴奋性的长期变化。
