Effects of repetitive transcranial magnetic stimulation combined with exercise training on pa-tients with incomplete spinal cord injuries
Objective To explore the effects of repetitive transcranial magnetic stimulation(rTMS)com-bined with exercise training on pain,muscle tone,and quality of life in patients with incomplete spinal cord injuries(ISCI).Methods A total of 64 patients with ISCI admitted to our hospital from Aug.2019 to Aug.2021 were pro-spectively selected,including 37 males and 27 females.The average age was 49.8 years,ranging from 22 to 78 years.The course of diseases ranged from 3 to 12 months,6.6 months on average;the body mass index(BMI)was 21-31 kg/m2,23.28 kg/m2 on average.ASIA classification showed 37 cases of grade C and 27 of grade D.The causes of injuries were road traffic accidents in 40 cases,falls in 18,and others in 6.Among them,31 cases under-went anterior decompression,16 cases underwent posterior laminectomy,and 17 cases had non-surgical treatment.Patients were divided into two groups by the randomized number table method:31 were enrolled in the control group and took simple exercise training(upper limb and hand function training,position transfer training,lower limb move-ment training,standing training,walking training;45 min once a day and 5 times a week for a continuous 4 weeks;the other 33 patients were enrolled in the rTMS group and received repetitive transcranial magnetic stimulation(using the YRDCCY-Ⅰ transcranial magnetic stimulation instrument to stimulate the primary motor cortex;once a day,5 times a week for 4 weeks)in additional to exercise training.The neuroelectrophysiological indexes[resting motor threshold(RMT)and motor evoked potential(MEP)],lower limb muscle strength indexes[peak torque(PT)and torque acceleration energy(TAE)of the extensor/flexor muscles,and quadriceps femoris to hamstrings muscle strength ratio(H/Q)],functional independence rating(FIM)scale,short-form McGill pain questionnaire(SF-MPQ)and Barthel index rating scale(BI)scores before and after treatment were compared between the two groups.The clinical efficacy and adverse reactions were also analyzed.Results The effective rate of the rTMS group was higher than the control group(93.9%vs.71.0%,P=0.015).After treatment,the RMT decreased and the MEP increased in both groups,but the RMT in the rTMS group was much lower(49.17%±4.25%vs.53.12%±5.08%)while the MEP was much higher(nV,2.63±0.51 vs.1.95±0.42)(both P<0.05).After treatment,the PT and TAE of flexor and extensor muscle groups,as well as H/Q,were increased in both groups,and the values were much higher in the rTMS group than in the control group(all P<0.05).After treatment,FIM and BI scores increased and SF-MPQ scores decreased in both groups,and consistently the results were much better in the rTMS group(all P<0.05 compared with the control group).The total rate of side reactions such as headache,vertigo and insomnia was 6.1%in the rTMS group and 3.2%in the control group,revealing no significant difference(P>0.05).Conclusion rTMS combined with exercise training can relieve patients'pain,promote the recovery of nerve function and lower limb muscle strength,and improve quality of life.It is worth promoting.
Spinal cord injuriesRepetitive transcranial magnetic stimulationExercise trainingPainMuscle tensionQuality of life
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