Lacerda Guilherme J M, Gonzalez-Gonzalez Luis Fernando, Pacheco-Barrios Kevin, Battistella Linamara R, Fregni Felipe
Neuromodulation Center, Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
Neurol Sci. 2025 Jun 5. doi: 10.1007/s10072-025-08249-w.
Spinal cord injury (SCI) impairs motor, autonomic, and sensory functions from nerve damage. Transcranial Magnetic Stimulation (TMS) enables non-invasive assessment of cortical excitability, essential for understanding neuroplasticity and its role in motor and cognitive recovery in SCI patients.
To identify associations between sociodemographic and clinical factors predicting corticospinal excitability in SCI patients.
We analyzed 102 individuals from the DEFINE cohort using cross-sectional analysis and linear and logistic regression models. TMS metrics were primary outcomes.
Age correlated positively with Motor Threshold (MT) (β = 0.29, p < 0.001), and non-white participants had higher MT than white participants (β = 4.79, p = 0.028). Thoracic and lumbar lesions were negatively associated with MT (β = -9.34, p < 0.001; β = -13.13, p < 0.001). Thoracic and lumbar lesions increased the odds of Motor Evoked Potentials (MEP) above the median by 62.2% (OR = 1.62, p < 0.001) and 54% (OR = 1.54, p = 0.011), respectively. Higher hand strength was linked to lower Intracortical Inhibition (ICI) (β = -0.0062, p = 0.023), while anxiety increased ICI (β = 0.0311, p = 0.003). Females had higher Intracortical Facilitation (ICF) than males (β = 0.14, p = 0.033), and lumbar lesions increased ICF compared to cervical (β = 0.147, p = 0.026).
Cortical excitability in subjects with SCI is influenced by age, race, lesion level, and psychological factors. The observed associations in motor threshold, theta activity, and lesion level underscore the need for personalized rehabilitation strategies.
脊髓损伤（SCI）会因神经损伤而损害运动、自主神经和感觉功能。经颅磁刺激（TMS）能够对皮质兴奋性进行无创评估，这对于理解神经可塑性及其在SCI患者运动和认知恢复中的作用至关重要。
确定预测SCI患者皮质脊髓兴奋性的社会人口统计学和临床因素之间的关联。
我们使用横断面分析以及线性和逻辑回归模型对DEFINE队列中的102名个体进行了分析。TMS指标为主要结果。
年龄与运动阈值（MT）呈正相关（β = 0.29，p < 0.001），非白人参与者的MT高于白人参与者（β = 4.79，p = 0.028）。胸段和腰段损伤与MT呈负相关（β = -9.34，p < 0.001；β = -13.13，p < 0.001）。胸段和腰段损伤使运动诱发电位（MEP）高于中位数的几率分别增加62.2%（OR = 1.62，p < 0.001）和54%（OR = 1.54，p = 0.011）。更高的手部力量与更低的皮质内抑制（ICI）相关（β = -0.0062，p = 0.023），而焦虑会增加ICI（β = 0.0311，p = 0.003）。女性的皮质内易化（ICF）高于男性（β = 0.14，p = 0.033），与颈段损伤相比，腰段损伤会增加ICF（β = 0.147，p = 0.026）。
SCI患者的皮质兴奋性受年龄、种族、损伤水平和心理因素影响。在运动阈值、θ活动和损伤水平方面观察到的关联强调了个性化康复策略的必要性。
