■经皮脊髓刺激(TSCS),一种非侵入性的脊髓刺激,已被证明可以改善脊髓损伤(SCI)患者的运动功能。然而,不同类型的TSCS电流的影响,包括直流(DC-TSCS),交流电(AC-TSCS),脊髓配对刺激对神经通路兴奋性的影响尚未得到系统研究。这项系统评价的目的是确定TSCS对任何水平的非进行性SCI成人神经通路兴奋性的影响。
■从成立到2022年6月,搜索了以下数据库:MEDLINEALL,Embase,WebofScience,科克伦图书馆,和临床试验。共筛选了4431篇摘要,包括23篇文章。
■19项研究使用TSCS在胸腰椎扩张下进行下肢康复(步态和平衡),4项研究使用颈椎TSCS进行上肢康复。16项研究通过报告不同的结果来测量脊髓兴奋性,包括霍夫曼反射(H反射),屈曲反射兴奋性,脊髓运动诱发电位(SMEP),颈髓鞘诱发电位(CMEP),和皮肤输入诱发的肌肉反应。七项研究使用经颅磁刺激(TMS)引起的运动诱发电位(MEP)测量皮质脊髓兴奋性,一项研究测量了TSCS后的体感诱发电位(SSEP)。我们的发现表明AC-TSCS后H反射和长潜伏期屈曲反射的幅度降低,随着SMEP和CMEP振幅的增加。此外,TSCS-TMS配对关联技术的应用导致脊髓反射抑制,表现为H反射和屈曲反射弧的振幅降低。在皮质脊髓兴奋性方面,来自5项研究的结果表明,在DC-TSCS之后,与下肢肌肉相关的MEP的振幅增加,除了涉及大脑上的重复TMS和脊柱上的DC-TSCS的配对联想刺激。在一项研究中,观察到SSEP的潜伏期有所改善。值得注意的是,证据的整体质量,通过修改后的唐斯和黑色质量评估进行评估,被认为是穷人。
■这篇综述揭示了系统证据,支持TSCS在脊髓和脊髓上脊髓后神经元回路重塑中的潜力。然而,它强调了更严格的必要性,高质量的调查。
UNASSIGNED: Transcutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level.
UNASSIGNED: The following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included.
UNASSIGNED: Nineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor.
UNASSIGNED: This review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.