Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation: a narrative review

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1219590 · Published: July 18, 2023

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

Spinal cord injury (SCI) can lead to serious sensory, motor, and physical dysfunction below the injured segment, as well as other complications affecting the quality of life and life expectancy of patients. Transcranial magnetic stimulation (TMS) is a non-invasive technique that can stimulate specific brain tissues and affect the activity of local neurons by transmitting magnetic pulses from copper coils. TMS has been widely used in evaluating SCI and treating motor dysfunction, NP, spasticity, neurogenic bladder, respiratory dysfunction, and other SCI complications.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
TMS can detect the residual corticospinal cord connection and nerve recovery after SCI, supplementing the international classification of SCI.
2
rTMS improves lower extremity motor function; one study found that rTMS with a frequency of 20 Hz, 1800 pulses, and 90% resting motor threshold intensity for 15 days could improve the lower limb function score and gait function of patients with SCI.
3
High-frequency rTMS can reduce spasticity in patients with multiple sclerosis or stroke; hence, rTMS may be a new method of relieving spasticity.

Research Summary

This review describes the pathophysiology of SCI as well as the basic principles and classification of TMS. We mainly focused on the latest research progress of TMS in the physiological evaluation of SCI as well as the treatment of motor dysfunction, neuropathic pain, spasticity, neurogenic bladder, respiratory dysfunction, and other complications. This review provides new ideas and future directions for SCI assessment and treatment.

Practical Implications

Improved SCI Evaluation

TMS offers a neurophysiological examination method to detect residual corticospinal cord connections and nerve recovery post-SCI, enhancing the subjective international classification of SCI.

Enhanced Motor Function Recovery

rTMS protocols, especially when combined with therapies like treadmill training, can significantly improve upper and lower limb motor function by increasing cortical excitability and plasticity.

Effective Spasticity Management

High-frequency rTMS has demonstrated the potential to reduce spasticity in SCI patients, providing a new approach to managing this common complication and potentially improving rehabilitation outcomes.

Study Limitations

1
TMS regimens used in most studies are different; hence, the appropriate stimulation targets and parameters remain unclear.
2
The effects of TMS on neuroplasticity in the central nervous system require further clarification, as the exact mechanisms remain unelucidated.
3
More large-scale, multicenter randomized controlled trials should be conducted to determine the efficacy and safety of TMS.

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