重复经颅磁刺激对脊髓损伤后神经性疼痛及大脑皮质兴奋性的影响

关键词：重复经颅磁刺激  脊髓损伤  神经性疼痛

Keywords:repetitive transcranial magnetic stimulation  spinal cord injury  neuropathic pain

摘要：

      摘要 目的：观察重复经颅磁刺激（rTMS）对脊髓损伤后神经性疼痛（NP）的治疗效果及其对脊髓损伤后大脑皮质兴奋性的影响。 方法：本研究选取在我科住院治疗的不完全性脊髓损伤后神经性疼痛患者共32例，用随机数字表法将32例患者分为实验组和对照组，试验组（n=17）给予常规物理治疗及右侧大脑M1区rTMS治疗，对照组（n=15）给予常规物理治疗及右侧大脑M1区假刺激。两组治疗均为每天1次，每周6天，连续治疗4周。于治疗前、治疗4周后对两组患者进行视觉模拟评分（VAS）测试，并对右侧大脑半球的静息运动阈值（RMT）、运动诱发电位（MEP）进行测试及分析。 结果：治疗4周后，试验组VAS评分降低，RMT波幅降低、MEP波幅增高，与对照组比较有显著性差异（P＜0.05）。 结论：rTMS能有效缓解脊髓损伤后神经性疼痛，其机制可能与大脑皮质兴奋性改变相关。

Abstract:

      Abstract Objective: To observe the effect of repetitive transcranial magnetic stimulation (rTMS) on neuropathic pain (NP) and cerebral cortex excitability of the patients with spinal cord injury. Method: A total of 32 inpatients with incomplete spinal cord injury, undergoing conventional physical therapy, were divided into two groups randomly. In experimental group, 17 patients received rTMS on right M1 region, meanwhile sham stimulation was given to those in control group once a day, 6 days a week for 4 weeks. At baseline and 4 weeks resting motor threshold (RMT) on the right side of the cerebral hemisphere and motor evoked potential(MEP) amplitude were measured and the visual analogue scale (VAS) was evaluated. Result: After 4 weeks treatment, the VAS score in the experimental group showed a obviously decreased (P＜0.05). RMT appeared a lower threshold and MEP tended a much higher amplitude than those in the control group (P＜0.05). Conclusion: rTMS can effectively alleviate neuropathic pain of the patients with spinal cord injury. The possible mechanisms might be related to the changes of the cortical excitability.