nTMS in spinal cord injury: Current evidence, challenges and a future direction

Spinal Cord Injury (SCI) has devastating consequences for patients and their families. Over the last few decades, a renewed interest in the utilization of non-invasive and cost-effective therapeutic technologies in the management of patients with SCI has emerged. This includes stimulation with navigated transcranial magnetic stimulation (nTMS) in order to improve the outcome for these patients alongside with existing clinical tools. nTMS has shown encouraging preliminary results in both clinical assessment and rehabilitation (motor and pain) of patients with SCI. However, different protocols – stimulation parameters, length of treatment and combination with other modalities – and patient selection criteria hampered definitive conclusions. So far, none of these have been adapted in regular clinical practice.

• 1
  nTMS can be used in assessment and treatment of patients with both traumatic and non-traumatic SCI. When it is being used in the assessment of SCI it can provide objective outcome measures that can add to the existing scales that are currently being used.
• 2
  Zdunczyk et al. found for the first time that patients with a reduced corticospinal excitability (CE), prolonged cortical silence period (CSP), and restricted motor area presented with more severe symptoms and had less favourable clinical outcomes, compared to those with compensatory recruitment of non-primary motor areas as part of neuroplasticity
• 3
  Onyiriuka et al. could demonstrate the functional cortical reorganisation in the case of a 67 year-old patient with thoracic intradural extramedullary tumour (meningioma).