Utility of transcranial magnetic stimulation in the assessment of spinal cord injury: Current status and future directions

Spinal cord injury (SCI) can lead to impairments in motor, sensory, and autonomic functions, significantly impacting the quality of life. Understanding the underlying neurophysiological mechanisms is crucial for improving prognostication and developing targeted therapies to enhance motor recovery. Transcranial magnetic stimulation (TMS) is a non-invasive technique used to assess the nervous system after SCI. TMS can help detect residual connections between the brain and muscles, even in cases where clinical exams suggest a complete injury. This information is useful for prognostication and monitoring recovery. TMS measures like MEP and silent period provide insights into the function of the brain and spinal cord after SCI. Changes in these measures can indicate how the brain is reorganizing itself after injury, which can inform rehabilitation strategies and predict potential for recovery.

• 1
  TMS can detect residual corticomotor connectivity after SCI, even when clinical assessments indicate a complete injury, which can help identify 'discomplete' SCI and potentially guide rehabilitation strategies.
• 2
  TMS-based measurements, such as MEP latency and amplitude, are correlated with the severity of SCI and can differentiate between individuals with varying degrees of motor impairment. These measures can also reflect neurophysiological changes following rehabilitation training.
• 3
  TMS can be used to study corticomotor reorganization after SCI, including changes in cortical muscle representations and intracortical circuits, providing insights into neuroplasticity and potential targets for neuromodulation therapies.