The Effects of Paired Associative Stimulation with Transcutaneous Spinal Cord Stimulation on Corticospinal Excitability in Multiple Lower-limb Muscles

Kaneko, Norio; Sasaki, Atsushi; Masugi, Yohei; Nakazawa, Kimitaka

doi:10.1016/j.neuroscience.2021.08.028

Cited by 3 publications

(2 citation statements)

References 53 publications

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“…It is vital to identify the capability of unmodulated tSCS to alter supraspinally driven responses compared to eSCS and modulated tSCS, in order to identify whether unique stimulation parameters are required for individual outcomes. Similarly, PAS with tSCS and TMS induced facilitation of corticospinal excitability for at least 30 min after the PAS, which is indicative of long-term potentiation (LTP)-like plasticity in the lower limb region of the primary motor cortex [81]. An important component of tSCS is its neuromodulatory effect on remote segments of the spinal cord, which must be considered during SCI rehabilitation.…”

Section: Mechanisms Of Tscs Recruitmentmentioning

confidence: 97%

Neural Substrates of Transcutaneous Spinal Cord Stimulation: Neuromodulation across Multiple Segments of the Spinal Cord

Barss

Parhizi

Porter

et al. 2022

JCM

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Transcutaneous spinal cord stimulation (tSCS) has the potential to promote improved sensorimotor rehabilitation by modulating the circuitry of the spinal cord non-invasively. Little is currently known about how cervical or lumbar tSCS influences the excitability of spinal and corticospinal networks, or whether the synergistic effects of multi-segmental tSCS occur between remote segments of the spinal cord. The aim of this review is to describe the emergence and development of tSCS as a novel method to modulate the spinal cord, while highlighting the effectiveness of tSCS in improving sensorimotor recovery after spinal cord injury. This review underscores the ability of single-site tSCS to alter excitability across multiple segments of the spinal cord, while multiple sites of tSCS converge to facilitate spinal reflex and corticospinal networks. Finally, the potential and current limitations for engaging cervical and lumbar spinal cord networks through tSCS to enhance the effectiveness of rehabilitation interventions are discussed. Further mechanistic work is needed in order to optimize targeted rehabilitation strategies and improve clinical outcomes.

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Section: Mechanisms Of Tscs Recruitmentmentioning

confidence: 97%

Neural Substrates of Transcutaneous Spinal Cord Stimulation: Neuromodulation across Multiple Segments of the Spinal Cord

Barss

Parhizi

Porter

et al. 2022

JCM

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show abstract

“…The results of recent computer modeling, preclinical and neurophysiological studies have provided evidence that TSCS can recruit low threshold, large-to-medium diameter afferents within the dorsal column of the spinal cord, which, in turn, can activate motor neurons involved in the regulation of movement ( Sdrulla et al, 2018 ; Filipp et al, 2019 ; Kazim et al, 2021 ; Taylor et al, 2021 ). Several recent clinical studies in the human SCI and neurologically intact populations have revealed that TSCS interventions can modulate spinal and/or cortical networks controlling the muscles after the intervention ( Hubli et al, 2013 ; Bocci et al, 2015 ; Powell et al, 2016 , 2018 ; Abualait and Ibrahim, 2020 ; Benavides et al, 2020 ; Hofstoetter et al, 2020 ; Al’joboori et al, 2021 ; Kaneko et al, 2021 ; Kazim et al, 2021 ; Barss et al, 2022 ). Studies investigating the excitability of spinal networks mainly employed the Hoffmann reflex (H-reflex), tibialis anterior (TA) flexion reflex arc, and SMEPs as outcomes ( Hubli et al, 2013 ; Knikou and Murray, 2019 ; Murray and Knikou, 2019b ).…”

Section: Introductionmentioning

confidence: 99%

Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review

Tajali,

Balbinot,

Pakosh

et al. 2024

Front. Neurosci.

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IntroductionTranscutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level.MethodsThe following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included.ResultsNineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor.DiscussionThis review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.

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Paired associative stimulation to enhance motor outcome in spinal cord injury: a systematic review of first evidence

Martino Cinnera,

Bonanno,

Calabrò

et al. 2024

Expert Review of Medical Devices

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The Effects of Paired Associative Stimulation with Transcutaneous Spinal Cord Stimulation on Corticospinal Excitability in Multiple Lower-limb Muscles

Cited by 3 publications

References 53 publications

Neural Substrates of Transcutaneous Spinal Cord Stimulation: Neuromodulation across Multiple Segments of the Spinal Cord

Neural Substrates of Transcutaneous Spinal Cord Stimulation: Neuromodulation across Multiple Segments of the Spinal Cord

Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review

Paired associative stimulation to enhance motor outcome in spinal cord injury: a systematic review of first evidence

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