P 249. Effects of repetitive transcranial magnetic stimulation on motor and gait improvement in incomplete spinal cord injury patients

Abstract

Incomplete spinal cord injury (SCI) patients have the potential to regain some ambulatory function and optimal reorganization of remaining circuits can contribute to this recovery. We hypothesized that repetitive transcranial magnetic stimulation (rTMS) may promote more active recovery of motor function at the beginning of gait training using electromechanical system. Seventeen incomplete SCI patients were randomized to receive active rTMS or sham stimulation coupled with rehabilitation therapy, when patients began gait training using electromechanical system. Active rTMS consisted of 20 daily sessions over the leg motor area (at 20 Hz). We compared lower extremity motor score (LEMS), ten meter walking test (10MWT) for walking speed, timed up and go (TUG), Walking Index for SCI (WISCI II) scale, Modified Ashworth Scale (MAS) and Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) at baseline, after the last session and 4 weeks later, in the active rTMS and sham stimulation groups. A significant improvement was observed after last rTMS session in the active group for LEMS and spasticity, but not for gait scales. Sham stimulation, did not induce any improvement in LEMS, gait assessment, neither in spasticity after last session. Twenty daily sessions of high-frequency rTMS can improve motor score and spasticity, but not walking speed in the lower limbs in incomplete SCI. The study provides evidence for the therapeutic potential of rTMS in the lower extremities in the early phase SCI rehabilitation.