Bastani Pouya B, Kordjazi Mohsen, Oveisgharan Shahram, Abdi Siamak
Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran; and.
Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, U.S.A.
J Clin Neurophysiol. 2023 Feb 1;40(2):173-179. doi: 10.1097/WNP.0000000000000874. Epub 2021 Nov 23.
Hereditary spastic paraplegia refers to a group of conditions characterized by a slow progression of spasticity in lower limbs resulting in gait abnormalities. Current treatment options have proven to be insufficient in terms of symptom alleviation. In this study, we tested the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on lower limb spasticity in patients with hereditary spastic paraplegia.
Eight patients were randomly assigned to receive either five sessions of active 5 Hz-rTMS ( n = 4) or sham rTMS ( n = 4). The primary outcome was a change in spasticity assessed by the modified Ashworth scale. Secondary outcomes were change in 10 m walking test, Fugl-Meyer assessment of lower extremity motor function, and quality-of-life short-form survey scores. Assessment of the outcomes was done before, upon completion, and 1 month after the intervention. We analyzed the data using repeated-measure analysis of variance.
Mean age of the participants was 38.5 (SD = 5.4) years, and 50% were women. Compared with sham rTMS, real rTMS was effective in decreasing modified Ashworth scale (rTMS × time: F [df = 2] = 7.44; P = 0.008). Real rTMS group had lower modified Ashworth scale scores at the end of rTMS sessions (estimate = -0.938; SE = 0.295; P = 0.019) and at the end of follow-up (estimate = -0.688; SE = 0.277; P = 0.048) compared with the sham rTMS group. Real and sham rTMS groups were not different in the secondary outcomes.
Repetitive transcranial magnetic stimulation is an effective method in reducing lower limb spasticity of patients with hereditary spastic paraplegia.
遗传性痉挛性截瘫是一组以下肢痉挛缓慢进展导致步态异常为特征的病症。目前的治疗方案在缓解症状方面已被证明是不足的。在本研究中，我们测试了重复经颅磁刺激（rTMS）对遗传性痉挛性截瘫患者下肢痉挛的有效性。
8名患者被随机分配接受5次5赫兹的主动rTMS治疗（n = 4）或假rTMS治疗（n = 4）。主要结局是通过改良Ashworth量表评估的痉挛变化。次要结局是10米步行测试的变化、Fugl-Meyer下肢运动功能评估以及生活质量简表调查得分。在干预前、干预完成时和干预后1个月对结局进行评估。我们使用重复测量方差分析来分析数据。
参与者的平均年龄为38.5（标准差 = 5.4）岁，50%为女性。与假rTMS相比，真正的rTMS在降低改良Ashworth量表评分方面有效（rTMS×时间：F[自由度 = 2] = 7.44；P = 0.008）。与假rTMS组相比，真正的rTMS组在rTMS疗程结束时（估计值 = -0.938；标准误 = 0.295；P = 0.019）和随访结束时（估计值 = -0.688；标准误 = 0.277；P = 0.048）的改良Ashworth量表评分更低。真正的rTMS组和假rTMS组在次要结局方面没有差异。
重复经颅磁刺激是降低遗传性痉挛性截瘫患者下肢痉挛的有效方法。
