Abstract
Cortical and spinal cord plasticity may be induced with non-invasive transcranial magnetic stimulation to encourage long term potentiation or depression of neuronal circuits. Such plasticity inducing stimulation provides an attractive approach to promote changes in sensorimotor circuits that have been degraded by spinal cord injury (SCI). If residual corticospinal circuits can be conditioned appropriately there should be the possibility that the changes are accompanied by functional recovery. This article reviews the attempts that have been made to restore sensorimotor function and to obtain functional benefits from the application of repetitive transcranial magnetic stimulation (rTMS) of the cortex following incomplete spinal cord injury. The confounding issues that arise with the application of rTMS, specifically in SCI, are enumerated. Finally, consideration is given to the potential for rTMS to be used in the restoration of bladder and bowel sphincter function and consequent functional recovery of the guarding reflex.
Highlights
An injury to the spinal cord may create sensory and motor loss or impairment that is likely to be permanent and can be severe enough to significantly impair quality of life
This animal study again highlights the difficulty of carrying out controlled studies in spinal cord injury (SCI) where individual variability in the location and extent of lesions may obscure the effect of treatments
Having determined the characteristics of corticospinal facilitation of the pudendo-anal reflex (PAR), and the frequency with which it can be elicited in incomplete spinal cord injury (iSCI), the intention is to see whether either high frequency (5 Hz) repetitive transcranial magnetic stimulation (rTMS) or paired associative stimulation (PAS) might reverse any maladaptive reflex plasticity induced by SCI and elicit persistent changes in either the PAR, the anal sphincter motor evoked potential (MEP) or facilitation of the PAR conditioned by single pulse transcranial magnetic stimulation (TMS)
Summary
An injury to the spinal cord may create sensory and motor loss or impairment that is likely to be permanent and can be severe enough to significantly impair quality of life. RTMS AND CORTICAL EXCITABILITY The basis for recovery of motor function from neurological trauma or disease by the use of repetitive non-invasive transcranial magnetic stimulation (TMS) is likely to be the induction of cortical and/or spinal cord plasticity Such stimulation is known to produce long term potentiation or depression of neuronal circuits depending on the exact protocol of stimulation employed. In an animal study of relevance, 10 Hz rTMS significantly improved the recovery of gait in rats when applied immediately after low thoracic (T10-T11) spinal cord compression injury but not following higher thoracic (T4–T5) injury (Poirrier et al, 2004) This animal study again highlights the difficulty of carrying out controlled studies in SCI where individual variability in the location and extent of lesions may obscure the effect of treatments.
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