Efeito da Estimulação Magnética Transcraniana de alta frequência sobre a função sensorial e motora de indivíduos com Lesão Medular Incompleta

Abstract

Incomplete Spinal Cord Injury (iSCI) is a condition generated by lesional processes that partially affect the integrity of the spinal cord, causing impairment in the sensorimotor function due to the decline in the functioning of the spinal cord. Such impairment directly impacts on physical, psychological and social aspects, with consequent reduction of quality of life and functional independence. Thus, effective rehabilitation requires the reduction of the damage caused by iSCI and, therefore, depends on techniques capable of favoring the neuroplasticity of the remaining medullary circuits. High frequency repetitive transcranial magnetic stimulation (rTMS) is a technique capable of inducing increased excitability of the primary motor cortex, corticospinal tract and spinal cord, facilitating the development of connectivity responsible for sensorimotor and functional improvement. The objective of this study was to evaluate the effects of high frequency applied rTMS on the lower limbs area in M1 on sensorimotor function and on spasticity levels in individuals with chronic iSCI. This double-blind, placebo-controlled study evaluated fifteen subjects with chronic iSCI (35.3 ± 7.9 years, mean ± standard deviation) included sequentially in five placebo rTMS sessions and five sessions of active rTMS at 5Hz separated by a washout period of one week. Clinical evaluations were done before and after the placebo and active rTMS. Statistically significant changes in the International Standards for Neurological Classification of Spinal Cord Injury Patients (ISNCSCI) motor scores (T (1, 14) = 5,359, P <0.001) were observed, which were accompanied by clinically significant effect sizes. The superficial sensitivity assessed by the ISNCSCI also showed statistically significant changes in the scores after active rTMS (T (1,14) = 2,223, P <0.043). No changes in spasticity were observed. No participant reported severe adverse events, except for transient headache after a few sessions. The present study found consistent statistical and clinical changes in sensorimotor function in individuals with chronic iSCI after active rTMS. Thus, this technique can be an effective form of rehabilitation in individuals with iSCI.