Repetitive Transcranial Magnetic Stimulation Enhances Recovery in Central Cord Syndrome Patients

Abstract

ObjectiveTo investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on neurological and functional recovery in patients with central cord syndrome (CCS) involving the upper extremities between the treated and non-treated sides of the treated group and whether the outcomes are comparable to that of the untreated control group.MethodsNineteen CCS patients were treated with high-frequency (20 Hz) rTMS over the motor cortex for 5 days. The stimulation side was randomly selected, and all the subjects received conventional occupational therapy during the rTMS-treatment period. Twenty CCS patients who did not receive rTMS were considered as controls. Clinical assessments, including those by the International Standard for Neurological Classification of Spinal Cord Injury, the Jebsen-Taylor Hand Function Test, and the O'Connor Finger Dexterity Test were performed initially and followed up for 1 month after rTMS treatment or 5 weeks after initial assessments.ResultsThe motor scores for upper extremities were increased and the number of improved cases was greater for the treated side in rTMS-treated patients than for the non-treated side in rTMS-treated patients or controls. The improved cases for writing time and score measured on the Jebsen-Taylor Hand Function Test were also significantly greater in number on the rTMS-treated side compared with the non-treated side and controls. There were no adverse effects during rTMS therapy or the follow-up period.ConclusionThe results of the application of high-frequency rTMS treatment to CCS patients suggest that rTMS can enhance the motor recovery and functional fine motor task performance of the upper extremities in such individuals.

Stimulation Parameters Used During Repetitive Transcranial Magnetic Stimulation for Motor Recovery and Corticospinal Excitability Modulation in SCI: A Scoping Review

“…It is important to keep in mind that when targeting the motor cortex (hand, arm, or leg M1), it is very likely to impact additional adjacent and remote connections and areas such as S1 (Belci et al, 2004;Kuppuswamy et al, 2011), due to the extended EF induced by the stimulation. This may explain the effects observed on sensory function (Belci et al, 2004) and the non-targeted side (Gomes-Osman and Field-Fote, 2015;Choi et al, 2019). Such bilateral and sensory effects may be of interest in SCI, given that stimulating the sensory cortex could have also benefit recovery (Pleger et al, 2006).…”

“…The clinical changes were maintained for weeks whereas the electrophysiological changes returned to pretreatment levels at follow-up. Choi et al (2019) specifically tested five sessions of HF-rTMS (20 Hz) in central cord syndrome patients, the most common type of SCI (Choi et al, 2019). They reported improved motor function with increased JTFHT time and scores and muscle strength thus demonstrating once again the potential of HF-rTMS to improve fine motor performance.…”

“…Subacute and incomplete SCI individuals may have an increased potential for functional recovery and may respond better to rTMS protocols in comparison to chronic and stable SCI, who may show an activity-dependent cortical and maladaptive plasticity (Eckert and Martin, 2017). Six studies out of 20 investigated subacute SCI (1 week to 6 months; Benito et al, 2012;Ji et al, 2015;Kumru et al, 2016;Sato et al, 2018;Choi et al, 2019;Zhao et al, 2020) and three included motor and sensory complete SCI (AIS A). These studies reported the feasibility and tolerability of rTMS even at early stages and in case of severe deficits.…”

Effects of Combined Upper Limb Robotic Therapy in Patients With Tetraplegic Spinal Cord Injury

“…Recently, there have been enhanced efforts to restore upper limb function in quadriplegia patients due to CNS injury, such as a stroke or SCI. These efforts include various types of exercise therapy, tendon/nerve transfer surgery, electrical stimulation, functional electrical stimulation, upper limb RT, and repetitive transcranial magnetic stimulation [31-35]. Among these, upper limb RT is emerging as a promising therapy in CNS injury patients, chiefly because of its advantage in intensive repetitive training.…”

Research on Assisting Clinicians to Operate rTMS Precisely Based on the Coil Magnetic Field Spatial Distribution With Magnetic Resonance Imaging Navigation

“…In recent years, more and more attention have been paid to the physiological effects of rTMS on brain function. Certain effects have been achieved in the treatment of nervous system diseases such as depression (McClintock et al, 2018), central cord syndrome (Choi et al, 2019), stroke (Unluer et al, 2019), and chronic neuropathic pain (Moisset and Lefaucheur, 2019). Among them, the accuracy of stimulation is the premise of its therapeutic effect.…”