Published online Oct 6, 2019. doi: 10.12998/wjcc.v7.i19.3120
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
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.
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.
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.