Descending motor pathways and cortical physiology after spinal cord injury assessed by transcranial magnetic stimulation: a systematic review

Nardone, Raffaele; Höller, Yvonne; Brigo, Francesco; Orioli, Andrea; Tezzon, Frediano; Schwenker, Kerstin; Christova, Monica; Golaszewski, Stefan; Trinka, Eugen

doi:10.1016/j.brainres.2014.09.036

Cited by 42 publications

(44 citation statements)

References 91 publications

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“…As treatment over M1 was also shown to be effective for other chronic pain states [50][51][52], this treatment might be promising for future clinical applications. However, double-blinded studies with larger sample sizes are needed to understand the functional changes at brain level and their effect on pain [53].…”

Section: Key Pointsmentioning

confidence: 99%

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Huber

Curt

Freund

2015

Current Opinion in Neurology

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PURPOSE OF REVIEW: This review will highlight the latest findings from neuroimaging studies that track structural and functional changes within the central nervous system at both the brain and spinal cord levels following acute human spinal cord injury (SCI). The putative, underlying biological mechanisms of structural change (e.g. degradation of neural tissue) rostral to the lesion site will be discussed in relation to animal models of SCI and their potential value in clinical studies of human SCI. RECENT FINDINGS: Recent prospective studies in human acute SCI have begun to reveal the timecourse, spatial distribution and extent of structural changes following an acute SCI and their relation to functional outcome. Adaptive changes in sensory and motor pathways above the level of the lesion have prognostic value and complement clinical readouts. SUMMARY: The introduction of sensitive neuroimaging biomarkers will be an essential step forward in the implementation of interventional trials in which proof-of-concept is currently limited to clinical readouts, but more responsive measures are required to improve the sensitivity of clinical trials. Purpose of review This review will highlight the latest findings from neuroimaging studies that track structural and functional changes within the central nervous system at both the brain and spinal cord levels following acute human spinal cord injury (SCI). The putative, underlying biological mechanisms of structural change (e.g. degradation of neural tissue) rostral to the lesion site will be discussed in relation to animal models of SCI and their potential value in clinical studies of human SCI. Recent findingsRecent prospective studies in human acute SCI have begun to reveal the time-course, spatial distribution and extent of structural changes following an acute SCI and their relation to functional outcome. Adaptive changes in sensory and motor pathways above the level of the lesion have prognostic value and complement clinical readouts. SummaryThe introduction of sensitive neuroimaging biomarkers will be an essential step forward in the implementation of interventional trials in which proof-of-concept is currently limited to clinical readouts, but more responsive measures are required to improve the sensitivity of clinical trials.

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Section: Key Pointsmentioning

confidence: 99%

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Huber

Curt

Freund

2015

Current Opinion in Neurology

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“…For example, PAS pulse pairs are delivered once every 5 s. Repetitive TMS (rTMS) without concomitant PNS can have positive effects in incomplete SCI patients for 2-3 weeks; 11,12 however, in SCI patients, high-intensity TMS is needed to effectively activate the corticospinal tract, 13 and long-term use of high-frequency and high-intensity rTMS may be contraindicated for SCI patients with head injury, as rTMS reduces the seizure threshold. 13,14 In contrast, PAS utilizes less risky low-frequency TMS.…”

Section: Introductionmentioning

confidence: 99%

Long-term paired associative stimulation can restore voluntary control over paralyzed muscles in incomplete chronic spinal cord injury patients

Shulga

Lioumis

Zubareva

et al. 2016

Spinal Cord Ser Cases

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Emerging therapeutic strategies for spinal cord injury aim at sparing or restoring at least part of the corticospinal tract at the acute stage. Hence, approaches that strengthen the weak connections that are spared or restored are crucial. Transient plastic changes in the human corticospinal tract can be induced through paired associative stimulation, a noninvasive technique in which transcranial magnetic brain stimulation is synchronized with electrical peripheral nerve stimulation. A single paired associative stimulation session can induce transient plasticity in spinal cord injury patients. It is not known whether paired associative stimulation can strengthen neuronal connections persistently and have therapeutic effects that are clinically relevant. We recruited two patients with motor-incomplete chronic (one para-and one tetraplegic) spinal cord injuries. The patients received paired associative stimulation for 20-24 weeks. The paraplegic patient, previously paralyzed below the knee level, regained plantarflexion and dorsiflexion of the ankles of both legs. The tetraplegic patient regained grasping ability. The newly acquired voluntary movements could be performed by the patients in the absence of stimulation and for at least 1 month after the last stimulation session. In this unblinded proof-of-principle demonstration in two subjects, long-term paired associative stimulation induced persistent and clinically relevant strengthening of neural connections and restored voluntary movement in previously paralyzed muscles. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.

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“…6 TMS can detect corticospinal tract abnormalities not identified by neuroimaging. 3,4,6 In the patients with compressive myelopathies, TMS was found to be helpful in determining the functional significance of neuroimaging findings. TMS can supplement clinical examination and neuroimaging findings also in the assessment of the spinal cord injury level.…”

Section: Introductionmentioning

confidence: 99%

“…TMS can supplement clinical examination and neuroimaging findings also in the assessment of the spinal cord injury level. 3,4 However, reports of TMS use in pediatric acute myelitis are relatively rare, and mostly such works are case reports or small series consisting of 2-3 patients. 7 We have performed the investigation of corticospinal pathway characteristics in children with acute myelitis, with special attention toward clinical significance of TMS and its prognostic value in this case.…”

Section: Introductionmentioning

confidence: 99%

“…2 Clinical examination in children is sometimes unreliable, and standard neurophysiologic tests could be insufficient in setting precise diagnosis; thus, transcranial magnetic stimulation (TMS) is considered as one of the valuable diagnostic methods. 3,4 TMS is a method for focal noninvasive brain stimulation that is based on the principles of electromagnetic induction. 5 TMS is an effective diagnostic and a therapeutic technique with applications in neurology, psychiatry and rehabilitation medicine, which can provide insight into developmental neurology and neurophysiology in children.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic transcranial magnetic stimulation as a prognostic tool in children with acute transverse myelitis

et al. 2015

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Study design: We performed transcranial magnetic stimulation (TMS) in children with sequelae of acute transverse myelitis. Single-pulse TMS protocol was implemented. Twenty controls and 24 patients with myelitis were enrolled. TMS was performed on 12-24 day after the onset of the first symptoms, average on 16th day. Objectives: The objective of our study was to evaluate motor pathways in children with viral myelitis using the TMS technique. Setting: All investigations were performed in Scientific Research Institute for Children's Infections, Russia. Results: There were statistically significant differences between the groups on central motor conduction time and motor evoked potential (MEPs) amplitudes. MEP thresholds were elevated, and MEP shape was abnormal in 96% of patients with myelitis (n = 23). Three neurophysiologic patterns were observed: the presence of both cortical and spinal MEP, the absence of cortical MEP with the spinal MEP present and the total absence of both cortical and spinal MEP. Last finding was associated with paraplegia, resistant to any sort of treatment. Conclusion: Thus, myelitis in 96% of the cases causes neurophysiologic changes, which may be detected by TMS; the method may be used as a predicting tool. Spinal Cord (2016) 54, 226-228; doi:10.1038/sc.2015.129; published online 4 August 2015 INTRODUCTIONAcute transverse myelitis is the infrequent, severe and potentially devastating condition that has been estimated to occur with an annual worldwide incidence of 4 cases per 100 000 individuals. 1 In pediatric population, it often results in motor, sensory and autonomic dysfunction, with growing demand for reliable diagnostic and prognostic tools. 2 Clinical examination in children is sometimes unreliable, and standard neurophysiologic tests could be insufficient in setting precise diagnosis; thus, transcranial magnetic stimulation (TMS) is considered as one of the valuable diagnostic methods. 3,4 TMS is a method for focal noninvasive brain stimulation that is based on the principles of electromagnetic induction. 5 TMS is an effective diagnostic and a therapeutic technique with applications in neurology, psychiatry and rehabilitation medicine, which can provide insight into developmental neurology and neurophysiology in children. 6 TMS can detect corticospinal tract abnormalities not identified by neuroimaging. 3,4,6 In the patients with compressive myelopathies, TMS was found to be helpful in determining the functional significance of neuroimaging findings. TMS can supplement clinical examination and neuroimaging findings also in the assessment of the spinal cord injury level. 3,4 However, reports of TMS use in pediatric acute myelitis are relatively rare, and mostly such works are case reports or small series consisting of 2-3 patients. 7 We have performed the investigation of corticospinal pathway characteristics in children with acute myelitis, with special attention toward clinical significance of TMS and its prognostic value in this case.

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Descending motor pathways and cortical physiology after spinal cord injury assessed by transcranial magnetic stimulation: a systematic review

Cited by 42 publications

References 91 publications

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Tracking trauma-induced structural and functional changes above the level of spinal cord injury

Long-term paired associative stimulation can restore voluntary control over paralyzed muscles in incomplete chronic spinal cord injury patients

Diagnostic transcranial magnetic stimulation as a prognostic tool in children with acute transverse myelitis

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