Repetitive Transcranial Magnetic Stimulation for the Treatment of Spinal Cord Injury: Current Status and Perspective

Int. J. Mol. Sci., 2025 · DOI: https://doi.org/10.3390/ijms26020825 · Published: January 19, 2025

Spinal Cord Injury Neurology Neurorehabilitation

Simple Explanation

Spinal cord injury (SCI) disrupts neural circuits, leading to loss of function. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique that uses magnetic fields to modulate brain activity. rTMS can help reconstruct damaged circuits in the spinal cord, activate the brain's reorganization, modulate signals to motoneurons, and improve the spinal cord's environment for regeneration. rTMS has shown promise in treating motor dysfunction, spasticity, and neuropathic pain in SCI patients. Combining rTMS with other therapies, like neural progenitor cell transplantation, could further enhance regeneration and recovery.

Study Duration

Not specified

Participants

Review article, clinical trials referenced

Evidence Level

Review

Key Findings

1
rTMS can promote activity-dependent regeneration of corticospinal tract (CST) axonal projections and the recruitment of propriospinal neurons and circuits.
2
rTMS can enhance the functional connectivity of the cortex-thalamus and multiple brain regions and activate the hypothalamic pituitary adrenal (HPA) axis.
3
rTMS can decrease the levels of inflammatory factors, including IL-1β, interleukin-6, and TNFα, at the injured site.

Research Summary

This review discusses the principles and potential mechanisms of rTMS for treating SCI, including promoting the reconstruction of damaged circuits, activating cortical reorganization, modulating motoneuron inputs, and improving the microenvironment. The review provides an overview of the therapeutic effects of rTMS in SCI patients with motor dysfunction, spasticity, and neuropathic pain, while also addressing challenges and future prospects. The potential of combination therapy with neural progenitor cell transplantation is highlighted for synergistic effects on regeneration, relay formation, and functional connectivity.

Practical Implications

Motor Function Improvement

rTMS shows promising outcomes in improving motor function recovery in the upper and lower extremities of individuals with incomplete SCI, potentially enhancing cortical excitability and transmission of neural impulses.

Spasticity Alleviation

HF-rTMS may improve spasticity in patients with incomplete SCI by modulating corticospinal projections and affecting segmental spinal excitability, though electrophysiology results are heterogeneous.

Neuropathic Pain Reduction

rTMS applied over the motor cortex may reduce neuropathic pain after incomplete SCI, possibly mediated by distant mechanisms not associated with local changes at the motor cortex level.

Study Limitations

1
Studies on the underlying mechanism of rTMS therapy for SCI are still not sufficient or in-depth.
2
The safety and efficacy of rTMS applied to SCI patients remain controversial because of the high degree of heterogeneity among the studies, which is one of the barriers to the clinical application of rTMS to SCI patients.
3
There are significant inconsistencies in the protocols of rTMS, including variations in parameters, stimulus sites, and treatment courses.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury