Repetitive transcranial magnetic stimulation on the modulation of cortical and spinal cord excitability in individuals with spinal cord injury

2021 ◽  
pp. 1-11
Author(s):  
Thyciane Mendonça ◽  
Rodrigo Brito ◽  
Plínio Luna ◽  
Mayara Campêlo ◽  
Lívia Shirahige ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Sham Stimulation ◽  
Resting Motor Threshold ◽  
Cord Injury ◽  
Spinal Excitability

Background: Repetitive transcranial magnetic stimulation (rTMS) has been applied for modulating cortical excitability and treating spasticity in neurological lesions. However, it is unclear which rTMS frequency is most effective in modulating cortical and spinal excitability in incomplete spinal cord injury (SCI). Objective: To evaluate electrophysiological and clinical repercussions of rTMS compared to sham stimulation when applied to the primary motor cortex (M1) in individuals with incomplete SCI. Methods: A total of 11 subjects (35±12 years) underwent three experimental sessions of rTMS (10 Hz, 1 Hz and sham stimulation) in a randomized order at 90%intensity of the resting motor threshold and interspersed by a seven-day interval between sessions. The following outcome measures were evaluated: M1 and spinal cord excitability and spasticity in the moments before (baseline), immediately after (T0), 30 (T30) and 60 (T60) minutes after rTMS. M1 excitability was obtained through the motor evoked potential (MEP); spinal cord excitability by the Hoffman reflex (H-reflex) and homosynaptic depression (HD); and spasticity by the modified Ashworth scale (MAS). Results: A significant increase in cortical excitability was observed in subjects submitted to 10 Hz rTMS at the T0 moment when compared to sham stimulation (p = 0.008); this increase was also significant at T0 (p = 0.009), T30 (p = 0.005) and T60 (p = 0.005) moments when compared to the baseline condition. No significant differences were observed after the 10 Hz rTMS on spinal excitability or on spasticity. No inter-group differences were detected, or in the time after application of 1 Hz rTMS, or after sham stimulation for any of the assessed outcomes. Conclusions: High-frequency rTMS applied to M1 was able to promote increased cortical excitability in individuals with incomplete SCI for at least 60 minutes; however, it did not modify spinal excitability or spasticity.

Low-intensity repetitive transcranial magnetic stimulation decreases motor cortical excitability in humans

2006 ◽  
Vol 101 (2) ◽  
pp. 500-505 ◽  
Author(s):  
Gabrielle Todd ◽  
Stanley C. Flavel ◽  
Michael C. Ridding
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Threshold ◽  
Sham Stimulation ◽  
Motor Cortical Excitability ◽  
Resting Motor Threshold ◽  
Active Motor ◽  
Motor Cortical

Repetitive transcranial magnetic stimulation of the motor cortex (rTMS) can be used to modify motor cortical excitability in human subjects. At stimulus intensities near to or above resting motor threshold, low-frequency rTMS (∼1 Hz) decreases motor cortical excitability, whereas high-frequency rTMS (5–20 Hz) can increase excitability. We investigated the effect of 10 min of intermittent rTMS on motor cortical excitability in normal subjects at two frequencies (2 or 6 Hz). Three low intensities of stimulation (70, 80, and 90% of active motor threshold) and sham stimulation were used. The number of stimuli were matched between conditions. Motor cortical excitability was investigated by measurement of the motor-evoked potential (MEP) evoked by single magnetic stimuli in the relaxed first dorsal interosseus muscle. The intensity of the single stimuli was set to evoke baseline MEPs of ∼1 mV in amplitude. Both 2- and 6-Hz stimulation, at 80% of active motor threshold, reduced the magnitude of MEPs for ∼30 min ( P < 0.05). MEPs returned to baseline values after a weak voluntary contraction. Stimulation at 70 and 90% of active motor threshold and sham stimulation did not induce a significant group effect on MEP magnitude. However, the intersubject response to rTMS at 90% of active motor threshold was highly variable, with some subjects showing significant MEP facilitation and others inhibition. These results suggest that, at low stimulus intensities, the intensity of stimulation may be as important as frequency in determining the effect of rTMS on motor cortical excitability.

scholarly journals Efficacy of repetitive transcranial magnetic stimulation for improving lower limb function in individuals with neurological disorders: A systematic review and meta-analysis of randomized sham-controlled trials

2021 ◽  
Author(s):  
Søren Krogh ◽  
Anette B. Jønsson ◽  
Per Aagaard ◽  
Helge Kasch
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Transcranial Magnetic Stimulation ◽  
Muscle Strength ◽  
Outcome Measures ◽  
Lower Limb ◽  
Neurological Disorders ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Cord Injury

Objective: To determine the efficacy of repetitive transcranial magnetic stimulation vs sham stimulation on improving lower-limb functional outcomes in individuals with neurological disorders.  Data sources: PubMed, CINAHL, Embase and Scopus databases were searched from inception to 31 March 2020 to identify papers (n = 1,198). Two researchers independently reviewed studies for eligibility. Randomized clinical trials with parallel-group design, involving individuals with neurological disorders, including lower-limb functional outcome measures and published in scientific peer-reviewed journals were included.  Data extraction: Two researchers independently screened eligible papers (n = 27) for study design, clinical population characteristics, stimulation protocol and relevant outcome measures, and assessed study quality. Data synthesis: Studies presented a moderate risk of selection, attrition and reporting bias. An overall effect of repetitive transcranial magnetic stimulation was found for outcomes: gait (effect size [95% confidence interval; 95% CI]: 0.51 [0.29; 0.74], p = 0.003) and muscle strength (0.99 [0.40; 1.58], p = 0.001) and disorders: stroke (0.20 [0.00; 0.39], p = 0.05), Parkinson’s disease (1.01 [0.65; 1.37], p = 0.02) and spinal cord injury (0.50 [0.14; 0.85], p = 0.006), compared with sham. No effect was found for outcomes: mobility and balance. Conclusion: Supplementary repetitive transcranial magnetic stimulation may promote rehabilitation focused on ambulation and muscle strength and overall lower-limb functional recovery in individuals with stroke, Parkinson’s disease and spinal cord injury. Further evidence is needed to extrapolate these findings. a

scholarly journals Reduction of Spasticity With Repetitive Transcranial Magnetic Stimulation in Patients With Spinal Cord Injury

2010 ◽  
Vol 24 (5) ◽  
pp. 435-441 ◽  
Author(s):  
Hatice Kumru ◽  
Narda Murillo ◽  
Joan Vidal Samso ◽  
Josep Valls-Sole ◽  
Dylan Edwards ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Cord Injury
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