Motor and gait improvement in patients with incomplete spinal cord injury induced by high-frequency repetitive transcranial magnetic stimulation

Abstract

Objective: To assess the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremities motor score (LEMS) and gait in patients with motor incomplete spinal cord injury (SCI).

Method: The prospective longitudinal randomized, double-blind study assessed 17 SCI patients ASIA D. We assessed LEMS, modified Ashworth Scale (MAS), 10-m walking test (10MWT), Walking Index for SCI (WISCI II) scale, step length, cadence, and Timed Up and Go (TUG) test at baseline, after the last of 15 daily sessions of rTMS and 2 weeks later. Patients were randomized to active rTMS or sham stimulation. Three patients from the initial group of 10 randomized to sham stimulation entered the active rTMS group after a 3-week washout period. Therefore a total of 10 patients completed each study condition. Both groups were homogeneous for age, gender, time since injury, etiology, and ASIA scale. Active rTMS consisted of 15 days of daily sessions of 20 trains of 40 pulses at 20 Hz and an intensity of 90% of resting motor threshold. rTMS was applied with a double cone coil to the leg motor area.

Results: There was a significant improvement in LEMS in the active group (28.4 at baseline and 33.2 after stimulation; P = .004) but not in the sham group (29.6 at baseline, and 30.9 after stimulation; P = .6). The active group also showed significant improvements in the MAS, 10MWT, cadence, step length, and TUG, and these improvements were maintained 2 weeks later. Following sham stimulation, significant improvement was found only for step length and TUG. No significant changes were observed in the WISCI II scale in either group.

Conclusion: High-frequency rTMS over the leg motor area can improve LEMS, spasticity, and gait in patients with motor incomplete SCI.

Keywords: gait; spasticity; spinal cord injury; transcranial magnetic stimulation.

Figures

Figure 1.

Change in lower extremities motor score (LEMS) from baseline to last repetitive transcranial magnetic stimulation (rTMS) session for each patient in active and sham groups. Mean values are shown in bold. *Significant improvement was found in the active rTMS group.

Figure 2.

Group mean data for spasticity showing a significant improvement in the active repetitive transcranial magnetic stimulation (rTMS) group. MAS = modified Ashworth scale.

Figure 3.

Group mean data for functional outcomes showing a significant improvement in velocity, cadence, step length, and Timed Up and Go test (TUG) for the active repetitive transcranial magnetic stimulation (rTMS) group and for step length and TUG for the sham rTMS group. WISCI = Walking Index for Spinal Cord Injury.