The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury

Abstract

Efforts to find therapeutic methods that support spinal cord functional regeneration continue to be desirable. Natural recovery is limited, so high hopes are being placed on neuromodulation methods which promote neuroplasticity, such as repetitive transcranial magnetic stimulation (rTMS) and electrical stimulation used as treatment options for managing incomplete spinal cord injury (iSCI) apart from kinesiotherapy. However, there is still no agreement on the methodology and algorithms for treatment with these methods. The search for effective therapy is also hampered by the use of different, often subjective in nature, evaluation methods and difficulties in assessing the actual results of the therapy versus the phenomenon of spontaneous spinal cord regeneration. In this study, an analysis was performed on the database of five trials, and the cumulative data are presented. Participants (iSCI patients) were divided into five groups on the basis of the treatment they had received: rTMS and kinesiotherapy (N = 36), peripheral electrotherapy and kinesiotherapy (N = 65), kinesiotherapy alone (N = 55), rTMS only (N = 34), and peripheral electrotherapy mainly (N = 53). We present changes in amplitudes and frequencies of the motor units’ action potentials recorded by surface electromyography (sEMG) from the tibialis anterior—the index muscle for the lower extremity and the percentage of improvement in sEMG results before and after the applied therapies. The increase in values in sEMG parameters represents the better ability of motor units to recruit and, thus, improvement of neural efferent transmission. Our results indicate that peripheral electrotherapy provides a higher percentage of neurophysiological improvement than rTMS; however, the use of any of these additional stimulation methods (rTMS or peripheral electrotherapy) provided better results than the use of kinesiotherapy alone. The best improvement of tibialis anterior motor units’ activity in iSCI patients provided the application of electrotherapy conjoined with kinesiotherapy and rTMS conjoined with kinesiotherapy. We also undertook a review of the current literature to identify and summarise available works which address the use of rTMS or peripheral electrotherapy as neuromodulation treatment options in patients after iSCI. Our goal is to encourage other clinicians to implement both types of stimulation into the neurorehabilitation program for subjects after iSCI and evaluate their effectiveness with neurophysiological tests such as sEMG so further results and algorithms can be compared across studies. Facilitating the motor rehabilitation process by combining two rehabilitation procedures together was confirmed.

Comparison of Motor Evoked Potentials Neuromonitoring Following Pre- and Postoperative Transcranial Magnetic Stimulation and Intraoperative Electrical Stimulation in Patients Undergoing Surgical Correction of Idiopathic Scoliosis

“…The sEMG recordings were performed using the KeyPoint Diagnostic System (Medtronic A/S, Skøvlunde, Denmark) with patients in a supine position during the examination. For measurements, we applied standard, disposable Ag/AgCl surface recording electrodes (5 mm 2 of an active surface) with an active electrode placed on the muscle belly, a reference electrode placed on the distal tendon of the same muscle, and a ground electrode placed on the distal part of the examined muscle, according to the Guidelines of the International Federation of Clinical Neurophysiology-European Chapter [40][41][42][43][44]. Patients were instructed to contract the muscles under examination and make the strongest possible contraction of the muscles for 5 s. Three attempts were performed each time.…”

“…The normative values recorded in healthy volunteer subjects were then compared with the test results of the patients. More details on the methodology of acquisition and interpretation of ENG studies are described in other papers published by our team members [41,42].…”

“…The resistance between the electrode surface and the skin was decreased with electroconductive gel. The methodology of MEP recordings has been described in detail elsewhere [40][41][42][43][44].…”

Unveiling the Correlations between Clinical Assessment of Spasticity and Muscle Strength and Neurophysiological Testing of Muscle Activity in Incomplete Spinal Cord Injury Patients: The Importance of a Comprehensive Evaluation

“…Treatment approaches typically involve a combination of pharmacological and physiotherapeutic interventions aimed at mitigating the symptoms and improving functional outcomes [8][9][10][11][12]. Some neuromodulation methods also appear to be effective [13][14][15][16].…”

“…Most of the pathological symptoms and the spontaneous functional recovery phenomena develop during the first 3 months and, in most cases, reach a plateau by 9 months after injury; additional recovery may also occur up to 12-18 months post-injury [20]. Long-term neurophysiological outcomes of iSCI may be closely related to the level of the injury, the severity of the primary injury, and the progression of secondary injury, and they have been characterised in our previous studies with the usage of sEMG recordings from upper and lower extremities muscles [14][15][16]. The description of functional pathological consequences in muscle motor units in patients with iSCI immediately after spinal cord injury has been rarely described, which is another of the main reasons for undertaking the sEMG recordings in this work.…”