Lu YS, Tong P, Guo TC, Ding XH, Zhang S, Zhang XJ. Effects of combined rTMS and visual feedback on the rehabilitation of supernumerary phantom limbs in a patient with spinal cord injury: A case report. World J Clin Cases 2019; 7(19): 3120-3125 [PMID: 31624763 DOI: 10.12998/wjcc.v7.i19.3120]
Corresponding Author of This Article
Tie-Cheng Guo, MD, Chief Physician, Associate Professor, Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jie Fang Avenue, Hankou District, Wuhan 430030, Hubei Province, China. pmr@tjh.tjmu.edu.cn
Research Domain of This Article
Rehabilitation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yin-Shan Lu, Tie-Cheng Guo, Xin-Hua Ding, Song Zhang, Xiu-Juan Zhang, Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Yin-Shan Lu, Department of Rehabilitation Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
Pei Tong, Department of Rehabilitation Medicine, Taikang Tongji (Wuhan) Hospital, Wuhan 430000, Hubei Province, China
Xiu-Juan Zhang, Department of Rehabilitation Medicine, Chengdu Second People's Hospital, Chengdu 610011, Sichuan Province, China
Author contributions: Lu YS contributed to the collection and analysis of the clinical data, drafting of the article, and revision of the article; Tong P collected the patient’s clinical data and drafted the article; Guo TC contributed to the design of the study, revision of the article, and final approval of the article; Ding XH contributed to analysis and interpretation of the imaging; Zhang S and Zhang XJ participated in patient treatment and collection and analysis of the clinical data; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient’s son for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tie-Cheng Guo, MD, Chief Physician, Associate Professor, Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jie Fang Avenue, Hankou District, Wuhan 430030, Hubei Province, China. pmr@tjh.tjmu.edu.cn
Telephone: +86-27-69378391 Fax: +86-27-69378391
Received: July 1, 2019 Peer-review started: July 1, 2019 First decision: July 31, 2019 Revised: August 24, 2019 Accepted: September 11, 2019 Article in press: September 11, 2019 Published online: October 6, 2019 Processing time: 91 Days and 19.3 Hours
Abstract
BACKGROUND
Supernumerary phantom limb (SPL) caused by spinal cord injury (SCI) has previously been reported in several studies. However, the mechanisms and management of SPL in SCI patients are still not fully understood. Herein, we report a rare case of SPL in a patient with incomplete SCI.
CASE SUMMARY
A 46-year-old man complained of four hands 7 d after SCI. He was diagnosed with SPL complicated with actual limb neuropathic pain. Following a period of treatment with neurotrophic agents and Chinese traditional and analgesic medications, SPL symptoms and actual limb pain did not improve. However, his symptoms gradually lessened after combined treatment with high-frequency repetitive transcranial magnetic stimulation (rTMS), a promising neuromodulation technique, over the M1 cortex and visual feedback. After 7 wk of this treatment, SPL disappeared completely and actual limb pain was significantly relieved.
CONCLUSION
Cerebral plasticity changes may be a mechanism underlying the occurrence of non-painful SPL in SCI patients, and high-frequency rTMS applied to the M1 cortex could be a promising treatment method for SPL.
Core tip: Supernumerary phantom limb (SPL) is rare in spinal cord injury (SCI). We report a rare case of painless SPL in a patient with incomplete SCI. Repetitive transcranial magnetic stimulation (rTMS) was first used in the treatment of SPL. The combination of rTMS and visual feedback showed positive effects on the recovery of SPL. This case indicates that the pathogenesis of painless SPL in SCI could include cerebral plasticity and some of the mechanisms assumed in amputees. Furthermore, it demonstrated that high-frequency rTMS applied to the M1 cortex is a promising method for modulating SPL in SCI patients.
