Abstract
Repetitive transcranial magnetic stimulation (rTMS) may support motor function recovery in patients with incomplete spinal cord injury (iSCI). Its effectiveness mainly depends on the applied algorithm. This clinical and neurophysiological study aimed to assess the effectiveness of high-frequency rTMS in iSCI patients at the C2–Th12 levels. rTMS sessions (lasting 3–5 per month, from 2 to 11 months, 5 months on average) were applied to 26 iSCI subjects. The motor cortex was bilaterally stimulated with a frequency at 20–25 Hz and a stimulus strength that was 70–80% of the resting motor threshold (15.4–45.5% maximal output) during one therapeutic session. Surface electromyography (sEMG) recordings at rest and during maximal contractions and motor evoked potential (MEP) recordings were performed from the abductor pollicis brevis (APB) and the tibialis anterior (TA) muscles. The same neurophysiological studies were also performed in patients treated with kinesiotherapy only (K group, n = 25) and compared with patients treated with both kinesiotherapy and rTMS (K + rTMS). A decrease in sEMG amplitudes recorded at rest from the APB muscles (p = 0.001) and an increase in sEMG amplitudes during the maximal contraction of the APB (p = 0.001) and TA (p = 0.009) muscles were found in the K + rTMS group. A comparison of data from MEP studies recorded from both APB and TA muscles showed significant changes in the mean amplitudes but not in latencies, suggesting a slight improvement in the transmission of spinal efferent pathways from the motor cortex to the lower spinal centers. The application of rTMS at 20–25 Hz reduced spasticity in the upper extremity muscles, improved the recruitment of motor units in the upper and lower extremity muscles, and slightly improved the transmission of efferent neural impulses within the spinal pathways in patients with C2–Th12 iSCI. Neurophysiological recordings produced significantly better parameters in the K + rTMS group of patients after therapy. These results may support the hypothesis about the importance of rTMS therapy and possible involvement of the residual efferent pathways including propriospinal neurons in the recovery of the motor control of iSCI patients.
Highlights
We have compared neurophysiological data in incomplete spinal cord injury (iSCI) patients treated only with kinesiotherapy and those treated with kinesiotherapy and Repetitive transcranial magnetic stimulation (rTMS) to prove the effect of repetitive magnetic stimulation included in the current standard of care
The rTMS therapy evoked a decrease in surface electromyography (sEMG) amplitudes in both the abductor pollicis brevis (APB)
The studied group of iSCI patients did not present the pathology of APB muscle mo-10 of 16 tor units during maximal contractions before treatment, but the data in Figure 5C that indicates the improvement in their activity after the rTMS therapy, which was significant at p = 0.001, is convincing
Summary
An increasing number of studies provide evidence that transcranial magnetic stimulation (rTMS), together with the other classical rehabilitation methods, such as physical creativecommons.org/licenses/by/ 4.0/). RTMS is known to evoke the long-term potentiation or depression of neuronal circuits’ activity (on the supraspinal and/or spinal levels) depending on the accepted protocol, including the widely applied stimuli algorithm [2,3,4,5,6,7]. Paresis and spasticity, two main clinical symptoms in patients with an iSCI, should change following rTMS therapy [8]. Both the mechanism and structures within the central nervous system responsible for positive treatment results remain unknown. Our previous study on the short-term results from rTMS in patients with a C4–Th2 Many of the studies on the treatment of iSCI patients describe this phenomenon as “functional recovery” [9,10,11].
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