Application value of repetitive transcranial magnetic stimulation in rehabilitation of incomplete spinal cord injury

English Keywords:Incomplete spinal cord injury  Repetitive transcranial magnetic stimulation  Pain  Motor function  Quality of life

English Abstract:

  【Abstract】 Objectives: To investigate the efficacy of repetitive transcranial magnetic stimulation(rTMS) in the treatment of incomplete spinal cord injury. Methods: 178 patients with incomplete spinal cord injury who were diagnosed and treated in our hospital from March 2015 to March 2021 with grade C-D of American Spinal Injury Association(ASIA), disease courses of less than 6 months, and no abnormal cognitive functions were prospectively enrolled. Using the random number table method, the patients were divided into observation group and control group with 89 cases each. There was no statistical difference in age, gender, course of disease, ASIA grade, and injury level between the two groups(P>0.05). The control group was given routine rehabilitation intervention, while the observation group was given rTMS(once a day, 5 times a week, continuous treatment for 10 weeks) on the intervention basis of the control group. Before the intervention and at 6 and 10 weeks of the intervention, the pain rating index(PRI), visual analogue scale(VAS) and present pain index(PPI) were measured using the short-form of McGill pain questionnaire(SF-MPQ). Among them, the PRI includes the PRI-sensory(PRI-S) and the PRI-affective(PRI-A). Modified Ashworth scale(MAS), walking index for spinal cord injury Ⅱ(WISCI Ⅱ), and spinal cord independence measure(SCIM) were used to assess the muscle tone and lower extremity function; Hamilton anxiety scale(HAMA) and Hamilton depression scale(HAMD) were used to assess anxiety and depression; 36-item short-form health survey(SF-36) was applied to evaluate the quality of life; and the magnetic stimulator was used to measure motor evoked potential(MEP) and resting motor threshold(RMT). Results: There was no significant difference in PRI-S, PRI-A, VAS and PPI scores between the two groups before intervention(P>0.05), while those values of both groups at 6 and 10 weeks after intervention were lower than before intervention(P<0.05), and the observation group was lower than the control group(P<0.05). The MAS, WISCI Ⅱ and SCIM scores between the two groups before intervention showed no significant difference(P>0.05). The MAS scores of both groups at 6 and 10 weeks after intervention were lower than those before intervention, while the WISCI Ⅱ and SCIM scores were higher than before intervention(P<0.05). The MAS scores of the observation group at 6 and 10 weeks of intervention were lower than those of the control group, while the WISCI Ⅱ and SCIM scores were higher than those of the control group(P<0.05). There was no significant difference in HAMA, HAMD and SF-36 scores between the two groups before intervention(P>0.05). The HAMA and HAMD scores of both groups at 6 and 10 weeks after intervention were lower than those before intervention(P<0.05), while the SF-36 scores were higher than before intervention(P<0.05). The HAMA and HAMD scores of the observation group at 6 and 10 weeks were lower than those of the control group, and the SF-36 score was higher than that of the control group(P<0.05). There was no significant difference in MEP amplitude and RMT between the two groups before intervention(P>0.05). The MEP amplitude in the observation group was higher than that in the control group at 6 and 10 weeks after intervention(P<0.05), and the RMT was lower than that in the control group(P<0.05). Conclusions: rTMS can reduce neuropathic pain in patients with incomplete spinal cord injury, improve cortical excitability, lower limb motor function and quality of life, reduce anxiety and depression, and help patients recover.