Cargando…

The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury

Repetitive transcranial magnetic stimulation (rTMS) may support motor function recovery in patients with incomplete spinal cord injury (iSCI). Its effectiveness mainly depends on the applied algorithm. This clinical and neurophysiological study aimed to assess the effectiveness of high-frequency rTM...

Descripción completa

Detalles Bibliográficos
Autores principales: Wincek, Agnieszka, Huber, Juliusz, Leszczyńska, Katarzyna, Fortuna, Wojciech, Okurowski, Stefan, Chmielak, Krzysztof, Tabakow, Paweł
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268291/
https://www.ncbi.nlm.nih.gov/pubmed/34279459
http://dx.doi.org/10.3390/jcm10132975
_version_ 1783720323772841984
author Wincek, Agnieszka
Huber, Juliusz
Leszczyńska, Katarzyna
Fortuna, Wojciech
Okurowski, Stefan
Chmielak, Krzysztof
Tabakow, Paweł
author_facet Wincek, Agnieszka
Huber, Juliusz
Leszczyńska, Katarzyna
Fortuna, Wojciech
Okurowski, Stefan
Chmielak, Krzysztof
Tabakow, Paweł
author_sort Wincek, Agnieszka
collection PubMed
description Repetitive transcranial magnetic stimulation (rTMS) may support motor function recovery in patients with incomplete spinal cord injury (iSCI). Its effectiveness mainly depends on the applied algorithm. This clinical and neurophysiological study aimed to assess the effectiveness of high-frequency rTMS in iSCI patients at the C2–Th12 levels. rTMS sessions (lasting 3–5 per month, from 2 to 11 months, 5 months on average) were applied to 26 iSCI subjects. The motor cortex was bilaterally stimulated with a frequency at 20–25 Hz and a stimulus strength that was 70–80% of the resting motor threshold (15.4–45.5% maximal output) during one therapeutic session. Surface electromyography (sEMG) recordings at rest and during maximal contractions and motor evoked potential (MEP) recordings were performed from the abductor pollicis brevis (APB) and the tibialis anterior (TA) muscles. The same neurophysiological studies were also performed in patients treated with kinesiotherapy only (K group, n = 25) and compared with patients treated with both kinesiotherapy and rTMS (K + rTMS). A decrease in sEMG amplitudes recorded at rest from the APB muscles (p = 0.001) and an increase in sEMG amplitudes during the maximal contraction of the APB (p = 0.001) and TA (p = 0.009) muscles were found in the K + rTMS group. A comparison of data from MEP studies recorded from both APB and TA muscles showed significant changes in the mean amplitudes but not in latencies, suggesting a slight improvement in the transmission of spinal efferent pathways from the motor cortex to the lower spinal centers. The application of rTMS at 20–25 Hz reduced spasticity in the upper extremity muscles, improved the recruitment of motor units in the upper and lower extremity muscles, and slightly improved the transmission of efferent neural impulses within the spinal pathways in patients with C2–Th12 iSCI. Neurophysiological recordings produced significantly better parameters in the K + rTMS group of patients after therapy. These results may support the hypothesis about the importance of rTMS therapy and possible involvement of the residual efferent pathways including propriospinal neurons in the recovery of the motor control of iSCI patients.
format Online
Article
Text
id pubmed-8268291
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-82682912021-07-10 The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury Wincek, Agnieszka Huber, Juliusz Leszczyńska, Katarzyna Fortuna, Wojciech Okurowski, Stefan Chmielak, Krzysztof Tabakow, Paweł J Clin Med Article Repetitive transcranial magnetic stimulation (rTMS) may support motor function recovery in patients with incomplete spinal cord injury (iSCI). Its effectiveness mainly depends on the applied algorithm. This clinical and neurophysiological study aimed to assess the effectiveness of high-frequency rTMS in iSCI patients at the C2–Th12 levels. rTMS sessions (lasting 3–5 per month, from 2 to 11 months, 5 months on average) were applied to 26 iSCI subjects. The motor cortex was bilaterally stimulated with a frequency at 20–25 Hz and a stimulus strength that was 70–80% of the resting motor threshold (15.4–45.5% maximal output) during one therapeutic session. Surface electromyography (sEMG) recordings at rest and during maximal contractions and motor evoked potential (MEP) recordings were performed from the abductor pollicis brevis (APB) and the tibialis anterior (TA) muscles. The same neurophysiological studies were also performed in patients treated with kinesiotherapy only (K group, n = 25) and compared with patients treated with both kinesiotherapy and rTMS (K + rTMS). A decrease in sEMG amplitudes recorded at rest from the APB muscles (p = 0.001) and an increase in sEMG amplitudes during the maximal contraction of the APB (p = 0.001) and TA (p = 0.009) muscles were found in the K + rTMS group. A comparison of data from MEP studies recorded from both APB and TA muscles showed significant changes in the mean amplitudes but not in latencies, suggesting a slight improvement in the transmission of spinal efferent pathways from the motor cortex to the lower spinal centers. The application of rTMS at 20–25 Hz reduced spasticity in the upper extremity muscles, improved the recruitment of motor units in the upper and lower extremity muscles, and slightly improved the transmission of efferent neural impulses within the spinal pathways in patients with C2–Th12 iSCI. Neurophysiological recordings produced significantly better parameters in the K + rTMS group of patients after therapy. These results may support the hypothesis about the importance of rTMS therapy and possible involvement of the residual efferent pathways including propriospinal neurons in the recovery of the motor control of iSCI patients. MDPI 2021-07-02 /pmc/articles/PMC8268291/ /pubmed/34279459 http://dx.doi.org/10.3390/jcm10132975 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wincek, Agnieszka
Huber, Juliusz
Leszczyńska, Katarzyna
Fortuna, Wojciech
Okurowski, Stefan
Chmielak, Krzysztof
Tabakow, Paweł
The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury
title The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury
title_full The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury
title_fullStr The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury
title_full_unstemmed The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury
title_short The Long-Term Effect of Treatment Using the Transcranial Magnetic Stimulation rTMS in Patients after Incomplete Cervical or Thoracic Spinal Cord Injury
title_sort long-term effect of treatment using the transcranial magnetic stimulation rtms in patients after incomplete cervical or thoracic spinal cord injury
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8268291/
https://www.ncbi.nlm.nih.gov/pubmed/34279459
http://dx.doi.org/10.3390/jcm10132975
work_keys_str_mv AT wincekagnieszka thelongtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT huberjuliusz thelongtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT leszczynskakatarzyna thelongtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT fortunawojciech thelongtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT okurowskistefan thelongtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT chmielakkrzysztof thelongtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT tabakowpaweł thelongtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT wincekagnieszka longtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT huberjuliusz longtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT leszczynskakatarzyna longtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT fortunawojciech longtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT okurowskistefan longtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT chmielakkrzysztof longtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury
AT tabakowpaweł longtermeffectoftreatmentusingthetranscranialmagneticstimulationrtmsinpatientsafterincompletecervicalorthoracicspinalcordinjury