Liu Xinyu, Dai Chunqiu, Gao Ming, Lin Xiaodong, Xi Xiao, Wu Xiangbo, Cheng Guiqing, Han Tao, Li Qiaozhen, Lu Yixing, Sun Xiaolong, Yuan Hua
Department of Rehabilitation Medicine, The First Affiliated Hospital, Air Force Medical University (Fourth Military Medical University) of Chinese People's Liberation Army, Xi'an, Shaanxi, People's Republic of China.
Department of Rehabilitation Medicine, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, People's Republic of China.
J Pain Res. 2025 Aug 11;18:4003-4018. doi: 10.2147/JPR.S517353. eCollection 2025.
PURPOSE: Neuropathic pain (NP) is a major and debilitating complication of spinal cord injury (SCI), frequently occurring bilaterally below the injury level. Repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1) is suggested as a treatment for NP following SCI (SCI-NP). However, the specific changes in corticospinal excitability (CSE) within the bilateral M1 remain unclear, hindering the development of optimized rTMS parameters for SCI-NP. PATIENTS AND METHODS: This retrospective study analyzed data from 625 SCI patients and 131 healthy controls. Motor-evoked potential (MEP) was used to assess CSE in the bilateral M1 hand areas. The hemispheric asymmetry of bilateral M1 CSE was measured by calculating the natural logarithm of the MEP amplitude ratio between the dominant hemisphere (DH) and non-dominant hemisphere (NDH), expressed as ln(DH/NDH amplitude). The study utilized correlation analysis and multiple linear regression to examine the associations between hemispheric CSE asymmetry and the course, severity, and emotional disturbances of NP. RESULTS: SCI patients experiencing NP exhibited lower MEP amplitude than those without NP in bilateral M1 hand areas, with a more pronounced decrease in NDH. Hemispheric CSE asymmetry was found to be elevated and positively correlated with NP course (r=0.213, =0.034), severity (r=0.317, =0.004), and emotional disturbances (r=0.294, =0.009). Notably, hemispheric CSE asymmetry was independently associated with NP severity and emotional disturbances, particularly in younger individuals (under 52 years), those with traumatic injuries, and those with non-cervical SCI. CONCLUSION: Hemispheric CSE asymmetry shows potential as a biomarker for assessing SCI-NP severity and emotional disturbances in SCI patients. High-frequency rTMS targeting bilateral M1 hand areas may provide improved analgesic effects. This finding could enhance neuropathic pain assessment and guide rTMS optimization, potentially improving the quality of life for individuals with SCI.
目的：神经性疼痛（NP）是脊髓损伤（SCI）的一种主要且使人衰弱的并发症，常在损伤平面以下双侧出现。建议将针对初级运动皮层（M1）的重复经颅磁刺激（rTMS）作为SCI后NP（SCI-NP）的一种治疗方法。然而，双侧M1内皮质脊髓兴奋性（CSE）的具体变化仍不清楚，这阻碍了为SCI-NP优化rTMS参数的发展。 患者与方法：这项回顾性研究分析了625例SCI患者和131名健康对照的数据。运动诱发电位（MEP）用于评估双侧M1手部区域的CSE。通过计算优势半球（DH）和非优势半球（NDH）之间MEP波幅比的自然对数来测量双侧M1 CSE的半球不对称性，以ln（DH/NDH波幅）表示。该研究利用相关性分析和多元线性回归来检验半球CSE不对称性与NP的病程、严重程度和情绪障碍之间的关联。 结果：经历NP的SCI患者在双侧M1手部区域的MEP波幅低于未患NP的患者，NDH中的下降更为明显。发现半球CSE不对称性升高，且与NP病程（r = 0.213，P = 0.034）、严重程度（r = 0.317，P = 0.004）和情绪障碍（r = 0.294，P = 0.009）呈正相关。值得注意的是，半球CSE不对称性与NP严重程度和情绪障碍独立相关，特别是在年龄较小（52岁以下）、有创伤性损伤以及非颈段SCI的患者中。 结论：半球CSE不对称性显示出作为评估SCI患者中SCI-NP严重程度和情绪障碍生物标志物的潜力。针对双侧M1手部区域的高频rTMS可能会提供更好的镇痛效果。这一发现可加强神经性疼痛评估并指导rTMS优化，有可能改善SCI患者的生活质量。
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