| 【Objective】To examined whether the modulation of excitability of the primary motor cortex with high frequency repetitive transcranial magnetic stimulation(r TMS) could modify lower limb spasticity in patients with incomplete spinal cord injury. 【Methods】18 patients(14 males, 4 females) with incomplete spinal cord injury(according to ASIA, who were scaled from B to D) were recruited from rehabilitation department of Tongji Hospital. Patients were aged from 15 to 47 years old with mean age of 32.5±12.1 years old. All patients received 20 days of daily sessions of active(n = 18) r TMS on the leg motor area(100 trains of 10 pulses at 10 Hz and an intensity of 90% of resting motor threshold). All patients were assessed by the Modified Ashworth Scale(MAS) before and after r TMS treatment. In this study, we evaluate the effect of high frequency, repetitive transcranial magnetic stimulation(r TMS) on the lower extremity spasticity and motor neuron excitability by comparing the difference of the mean latency of F- wave and H reflex, the ratio of the maximum amplitude of H reflex and the maximum amplitude of M wave(H/M) of these patients before and after the r TMS treatment. And analysis the correlation between the H/M and MAS in SCI lower extremity with muscle tone before and after the r TMS treatment respectively. 7 healthy participants were recruited as control group to measure the same neurophysiology index. 【Results】 A significant clinical improvement in lower limb spasticity was observed in patients following r TMS treatment. Compared with the score of MAS of before r TMS treatment, the score of post treatment were lower(pre 2.000±0.71, post1.528±0.401, p<0.05), and the differences were statistically significant. Compared with normal control group, the SCI group’s Flat-mean, Hlat-mean and H/M were higher, and the differences were statistically significant(p<0.05). A significant decrease of Flat-mean was measured following active r TMS while H reflex and H/M did not change. There was no correlation before or after r TMS treatment between H/M and MAS respectively. 【Conclusion】 High-frequency r TMS over the leg motor area can improve lower limb spasticity in patients with incomplete SCI. By comparing patients with SCI’s electrophysiological changes before and after r TMS, and combined with the clinical symptoms improved, showed that the effect of r TMS on incomplete SCI patients with lower limb spasticity symptoms improvement is supported by physiological changes. It is suggested that high frequency r TMS used as a treatment for the lower limb spasticity of patients with incomplete spinal cord injury treated by is worth to be widely used in clinic. |
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