Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 089M6, Badalona, Barcelona, Spain; Univ Autonoma de Barcelona, 08M93, Bellaterra, Cerdanyola del Vallès, Spain; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, 089M6, Badalona, Barcelona, Spain.
Brain Res Bull. 2019 Apr;147:86-91. doi: 10.1016/j.brainresbull.2019.02.002. Epub 2019 Feb 12.
The excitability of brainstem interneuronal circuits is partly under control from descending inputs. Since high frequency repetitive transcranial magnetic stimulation (rTMS) modulates cortical output, we hypothesized that it will also modulate brainstem functions. Such modulation may be different in healthy subjects than in subjects with spinal cord injury (SCI), submitted to an altered integration of body afferent inputs.
In this randomized, double-blind, sham-controlled trial, we recruited 22 subjects with SCI assigned to either real (n = 11) or sham (n = 11) rTMS and nine healthy subjects, who served as control group, receiving both real (at 20 Hz, with double cone coil over vertex) and sham rTMS separated by at least one week. We recorded the blink reflex (BR) to supraorbital nerve (SON) electrical stimulation and its modification by another conditioning SON, to study the BR excitability recovery (BRER), or a prepulse electrical stimulus to the right index finger, to study the BR inhibition by prepulse (BRIP). Subjects were examined immediately before and after either sham or real rTMS.
Real but not sham rTMS significantly reduced the area of the BR R2 response in both SCI and healthy subjects. There were no changes in BRER and BRIP.
rTMS over the vertex modulates brainstem reflexes with no significant differences between SCI and healthy subjects.
脑干中间神经元回路的兴奋性部分受到下行输入的控制。由于高频重复经颅磁刺激（rTMS）调节皮质输出，我们假设它也会调节脑干功能。这种调节在健康受试者和脊髓损伤（SCI）受试者中可能不同，后者的躯体传入输入整合受到改变。
在这项随机、双盲、假刺激对照试验中，我们招募了 22 名 SCI 受试者，分为真刺激（n=11）和假刺激（n=11）组，以及 9 名健康受试者作为对照组，他们接受了真刺激（20Hz，在顶点上方使用双锥线圈）和假刺激，两者间隔至少一周。我们记录了眶上神经（SON）电刺激的眨眼反射（BR）及其由另一个条件性 SON 引起的变化，以研究 BR 兴奋性恢复（BRER），或对右食指施加预激电刺激，以研究预激对 BR 的抑制（BRIP）。受试者在接受真刺激或假刺激之前和之后立即接受检查。
只有真刺激而非假刺激显著降低了 SCI 和健康受试者的 BR R2 反应面积。BRER 和 BRIP 没有变化。
顶点上方的 rTMS 调节了脑干反射，在 SCI 和健康受试者之间没有显著差异。
