Sato Shin, Kakuda Wataru, Sano Mitsuhiro, Kitahara Takamasa, Kiko Risa
Department of Rehabilitation Medicine, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan.
Department of Rehabilitation Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan.
Prog Rehabil Med. 2018 Jun 30;3:20180014. doi: 10.2490/prm.20180014. eCollection 2018.
Only a few researchers have therapeutically applied transcranial magnetic stimulation (TMS) for patients with spinal cord injury. The purpose of this case study was to evaluate the safety, feasibility, and efficacy of therapeutic TMS combined with rehabilitative training for a patient with tetraparesis resulting from incomplete spinal cord injury.
An 82-year-old male patient with incomplete spinal cord injury was admitted to our department for long-term rehabilitation. Eighteen days prior to admission, the patient sustained the injury in a fall. At admission to our department, the patient was diagnosed as having injury of the spinal cord at the C6 level. From the 76th day after admission, when the patient was considered to have attained a plateau state of recovery, application of therapeutic TMS was initiated using a double-cone coil. Two 15-min sessions of 10-Hz TMS were scheduled for daily application. Simultaneously, rehabilitative training was continuously provided. This patient received a total of 30 sessions of TMS over 19 days. Neither adverse effects nor deterioration of neurological symptoms was recognized during the intervention period. With this application of TMS, some improvements were evident in the American Spinal Injury Association motor score, the knee muscle strength, and the calf circumference.
This case study demonstrated the safety and feasibility of TMS combined with rehabilitative training in a patient with incomplete spinal cord injury. Our protocol featuring TMS might constitute a novel neurorehabilitation intervention for such patients; however, the efficacy of the protocol should be confirmed in a large number of patients.
仅有少数研究人员将经颅磁刺激（TMS）用于脊髓损伤患者的治疗。本病例研究的目的是评估治疗性TMS联合康复训练对一名因不完全性脊髓损伤导致四肢轻瘫患者的安全性、可行性和疗效。
一名82岁的男性不完全性脊髓损伤患者因长期康复入住我科。入院前18天，患者因跌倒受伤。入院时，患者被诊断为C6水平脊髓损伤。入院后第76天，当患者被认为已达到恢复平台期时，开始使用双锥线圈进行治疗性TMS。计划每天进行2次15分钟的10赫兹TMS治疗。同时，持续提供康复训练。该患者在19天内共接受了30次TMS治疗。在干预期间未发现不良反应或神经症状恶化。通过这种TMS应用，美国脊髓损伤协会运动评分、膝关节肌肉力量和小腿围度均有明显改善。
本病例研究证明了TMS联合康复训练在不完全性脊髓损伤患者中的安全性和可行性。我们以TMS为特色的方案可能构成对此类患者的一种新型神经康复干预措施；然而，该方案的疗效应在大量患者中得到证实。
