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Patel D, Banerjee R, Farooque K, Gupta D, Garg B, Kumar N, Thukral GH, Kochhar KP, Jain S. Restoring initial steps by intermittent theta burst stimulation in complete spinal cord injury patient: a case report. Spinal Cord Ser Cases 2024; 10:56. [PMID: 39098854 PMCID: PMC11298536 DOI: 10.1038/s41394-024-00669-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/19/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) causes damage to neurons and results in motor and sensory dysfunction. Intermittent theta burst stimulation (iTBS) has been used to induce neuronal and synaptic plasticity by applying a magnetic field in the brain. The plasticity induced in the cortex has an imperative role in the recovery of motor and sensory functioning. However, the effect of iTBS in complete SCI patients is still elusive. CASE PRESENTATION We report here the case of a 27-year-old female who sustained an L1 complete spinal cord injury (SCI) with an ASIA score of A. The patient lost all the sensory and motor functions below the level of injury. Intermittent theta burst stimulation (iTBS) was administered at 80% of the resting motor threshold over the M1 motor cortex, along with intensive rehabilitation training to promote sensorimotor function. DISCUSSION There was a partial recovery in functional, electrophysiological, and neurological parameters. The case report also demonstrates the safety and efficacy of iTBS in complete SCI patients. No adverse event has been observed in the patient during intervention sessions.
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Affiliation(s)
- Deeksha Patel
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Rohit Banerjee
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Kamran Farooque
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Gita H Thukral
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Kanwal Preet Kochhar
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India
| | - Suman Jain
- Brain Stimulation and Neuromodulation Laboratory, Department of Physiology, All India Institute of Medical Sciences, Delhi, 110029, India.
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Onyiriuka L, Aliaga-Arias JM, Patel S, Khan A, Ashkan K, Gullan R, Bhangoo R, Ahmed A, Grahovac G, Vergani F, Kailaya-Vasan A, Lavrador JP. Identifying functional cortical plasticity after spinal tumour resection using navigated transcranial magnetic stimulation. Ann R Coll Surg Engl 2024. [PMID: 38961733 DOI: 10.1308/rcsann.2024.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Our aim was to investigate the effectiveness of navigated transcranial magnetic stimulation (nTMS) brain mapping to characterise preoperative motor impairment caused by an intradural extramedullary (IDEM) tumour and postoperative cortical functional reorganisation. Preoperative and 1-year follow-up clinical, radiological and nTMS data from a case of thoracic spinal meningioma that underwent surgical resection of the lesion were collected and compared. A 67-year-old patient presented with severe progressive thoracic myelopathy (hypertonic paraparesis, clonus, insensate urinary retention) secondary to an IDEM tumour. Initial nTMS assessment showed bilateral upper limb representation with no positive responses for both lower limbs. He underwent successful surgical resection for his IDEM (meningioma WHO grade 1). At 1-year follow-up, the patient's gait was improved and his bladder function normalised. nTMS documented positive responses for both upper and lower limbs and a decrease in the area (right side: 1.01 vs 0.39cm2; left side: 1.92 vs 0.81cm2) and volume (right side: 344.2 vs 42.4uVcm2; left side: 467.1 vs 119uVcm2) of cortical activation for both upper limbs, suggesting a functional reorganisation of the motor areas after tumour resection. nTMS motor mapping and derived metrics can characterise preoperative motor deficit and cortical plasticity during follow-up after IDEM resection.
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Affiliation(s)
- L Onyiriuka
- King's College Hospital NHS Foundation Trust, UK
| | - J M Aliaga-Arias
- King's College Hospital NHS Foundation Trust, UK
- University of Brescia, Italy
| | - S Patel
- King's College Hospital NHS Foundation Trust, UK
- King's College London, UK
| | - A Khan
- King's College Hospital NHS Foundation Trust, UK
| | - K Ashkan
- King's College Hospital NHS Foundation Trust, UK
- King's College London, UK
| | - R Gullan
- King's College Hospital NHS Foundation Trust, UK
| | - R Bhangoo
- King's College Hospital NHS Foundation Trust, UK
| | - A Ahmed
- King's College Hospital NHS Foundation Trust, UK
- King's College London, UK
| | - G Grahovac
- King's College Hospital NHS Foundation Trust, UK
| | - F Vergani
- King's College Hospital NHS Foundation Trust, UK
| | - A Kailaya-Vasan
- King's College Hospital NHS Foundation Trust, UK
- King's College London, UK
| | - J P Lavrador
- King's College Hospital NHS Foundation Trust, UK
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Kataria M, Gupta N, Kumar A, Bhoriwal S, Singh A, Shekhar V, Bhatia R. Assessing the effectiveness of high frequency repetitive transcranial magnetic stimulation for post-mastectomy pain in breast cancer patients: A randomized controlled trial. Breast Cancer 2024:10.1007/s12282-024-01598-y. [PMID: 38796817 DOI: 10.1007/s12282-024-01598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients. METHODS We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST). RESULTS Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078). CONCLUSION The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies.
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Affiliation(s)
- Monika Kataria
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Aasheesh Kumar
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Akanksha Singh
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Varun Shekhar
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Renu Bhatia
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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Leszczyńska K, Huber J. The Role of Transcranial Magnetic Stimulation, Peripheral Electrotherapy, and Neurophysiology Tests for Managing Incomplete Spinal Cord Injury. Biomedicines 2023; 11:biomedicines11041035. [PMID: 37189653 DOI: 10.3390/biomedicines11041035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
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.
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Medina R, Ho A, Reddy R, Chen J, Castellanos J. Narrative review of current neuromodulation modalities for spinal cord injury. FRONTIERS IN PAIN RESEARCH 2023; 4:1143405. [PMID: 36969918 PMCID: PMC10033643 DOI: 10.3389/fpain.2023.1143405] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
Neuromodulation is a developing field of medicine that includes a vast array of minimally invasive and non-invasive therapies including transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), peripheral nerve stimulation, and spinal cord stimulation (SCS). Although the current literature surrounding the use of neuromodulation in managing chronic pain is abundant, there is an insufficient amount of evidence specifically regarding neuromodulation in patients with spinal cord injury (SCI). Given the pain and functional deficits that these patients face, that are not amenable to other forms conservative therapy, the purpose of this narrative review is to examine and assess the use of various neuromodulation modalities to manage pain and restore function in the SCI population. Currently, high-frequency spinal cord stimulation (HF-SCS) and burst spinal cord stimulation (B-SCS) have been shown to have the most promising effect in improving pain intensity and frequency. Additionally, dorsal root ganglion stimulation (DRG-S) and TMS have been shown to effectively increase motor responses and improve limb strength. Although these modalities carry the potential to enhance overall functionality and improve a patient's degree of disability, there is a lack of long-term, randomized-controlled trials in the current space. Additional research is warranted to further support the clinical use of these emerging modalities to provide improved pain management, increased level of function, and ultimately an overall better quality of life in the SCI population.
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Affiliation(s)
- Roi Medina
- Department of Physical Medicine and Rehabilitation, Lake Erie College of Osteopathic Medicine-Bradenton, Bradenton, FL, United States
- Correspondence: Roi Medina
| | - Alison Ho
- Department of Physical Medicine and Rehabilitation, Baylor University Medical Center, Dallas, TX, United States
| | - Rajiv Reddy
- UC San Diego Health, University of California San Diego, La Jolla, CA, United States
| | - Jeffrey Chen
- UC San Diego Health, University of California San Diego, La Jolla, CA, United States
| | - Joel Castellanos
- UC San Diego Health, University of California San Diego, La Jolla, CA, United States
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Cui Z, Lin J, Fu X, Zhang S, Li P, Wu X, Wang X, Chen W, Zhu S, Li Y. Construction of the dynamic model of SCI rehabilitation using bidirectional stimulation and its application in rehabilitating with BCI. Cogn Neurodyn 2023; 17:169-181. [PMID: 36704625 PMCID: PMC9871133 DOI: 10.1007/s11571-022-09804-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/04/2022] [Accepted: 03/26/2022] [Indexed: 01/29/2023] Open
Abstract
Patients with complete spinal cord injury have a complete loss of motor and sensory functions below the injury plane, leading to a complete loss of function of the nerve pathway in the injured area. Improving the microenvironment in the injured area of patients with spinal cord injury, promoting axon regeneration of the nerve cells is challenging research fields. The brain-computer interface rehabilitation system is different from the other rehabilitation techniques. It can exert bidirectional stimulation on the spinal cord injury area, and can make positively rehabilitation effects of the patient with complete spinal cord injury. A dynamic model was constructed for the patient with spinal cord injury under-stimulation therapy, and the mechanism of the brain-computer interface in rehabilitation training was explored. The effects of the three current rehabilitation treatment methods on the microenvironment in a microscopic nonlinear model were innovatively unified and a complex system mapping relationship from the microscopic axon growth to macroscopic motor functions was constructed. The basic structure of the model was determined by simulating and fitting the data of the open rat experiments. A clinical rehabilitation experiment of spinal cord injury based on brain-computer interface was built, recruiting a patient with complete spinal cord injury, and the rehabilitation training and follow-up were conducted. The changes in the motor function of the patient was simulated and predicted through the constructed model, and the trend in the motor function improvement was successfully predicted over time. This proposed model explores the mechanism of brain-computer interface in rehabilitating patients with complete spinal cord injury, and it is also an application of complex system theory in rehabilitation medicine. Supplementary Information The online version contains supplementary material available at 10.1007/s11571-022-09804-3.
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Affiliation(s)
- Zhengzhe Cui
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Juan Lin
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangxiang Fu
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | | | - Peng Li
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Xixi Wu
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weidong Chen
- Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China
| | - Shiqiang Zhu
- School of Mechanical Engineering, Zhejiang University, Hangzhou, China
| | - Yongqiang Li
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Wuxi Tongren Rehabilitation Hospital, Wuxi, China
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Zhao D, Zhang Y, Zheng Y, Li XT, Sun CC, Yang Q, Xie Q, Xu DS. Double-target neural circuit-magnetic stimulation improves motor function in spinal cord injury by attenuating astrocyte activation. Neural Regen Res 2022; 18:1062-1066. [PMID: 36254994 PMCID: PMC9827772 DOI: 10.4103/1673-5374.355768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Multi-target neural circuit-magnetic stimulation has been clinically shown to improve rehabilitation of lower limb motor function after spinal cord injury. However, the precise underlying mechanism remains unclear. In this study, we performed double-target neural circuit-magnetic stimulation on the left motor cortex and bilateral L5 nerve root for 3 successive weeks in a rat model of incomplete spinal cord injury caused by compression at T10. Results showed that in the injured spinal cord, the expression of the astrocyte marker glial fibrillary acidic protein and inflammatory factors interleukin 1β, interleukin-6, and tumor necrosis factor-α had decreased, whereas that of neuronal survival marker microtubule-associated protein 2 and synaptic plasticity markers postsynaptic densification protein 95 and synaptophysin protein had increased. Additionally, neural signaling of the descending corticospinal tract was markedly improved and rat locomotor function recovered significantly. These findings suggest that double-target neural circuit-magnetic stimulation improves rat motor function by attenuating astrocyte activation, thus providing a theoretical basis for application of double-target neural circuit-magnetic stimulation in the clinical treatment of spinal cord injury.
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Affiliation(s)
- Dan Zhao
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Department of Rehabilitation, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ye Zhang
- Department of Rehabilitation, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ya Zheng
- Department of Rehabilitation, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xu-Tong Li
- Department of Neurology, Zibo Centre Hospital, Zibo, Shandong Province, China
| | - Cheng-Cheng Sun
- Department of Rehabilitation, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Yang
- Department of Rehabilitation, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence to: Qing Xie, ; Dong-Sheng Xu, .
| | - Dong-Sheng Xu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Shanghai, China,Correspondence to: Qing Xie, ; Dong-Sheng Xu, .
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Sasaki N, Sato T, Yamatoku M, Yamano Y. Efficacy of repetitive transcranial magnetic stimulation for gait disturbance in HTLV-1 associated myelopathy. NeuroRehabilitation 2022; 51:519-526. [DOI: 10.3233/nre-220105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Human T-cell leukemia virus type 1 (HTLV-1) associated myelopathy (HAM) can damage the spinal cord, causing paraplegia, spasticity, and gait disturbance. Currently, there are few effective treatments. OBJECTIVE: We investigated the efficacy of repetitive transcranial magnetic stimulation (rTMS) on gait disturbance in patients with HAM. METHODS: rTMS at 10 Hz was applied to HAM patients aged 30–80 years with an Osame’s Motor Disability Score between 3 and 6. The stimulation site on the skull was the position where motor evoked potentials were most evidently elicited and leg motor areas were stimulated. Resting motor thresholds (minimum stimulation to induce motor evoked potential) were also determined. Each participant underwent 10 sessions of 2400 stimuli. Clinical measurements, including walking speed and stride length, were obtained. RESULTS: From 119 patients with HAM recruited, 12 were included in the rTMS group and 18 who did not undergo rTMS comprised the control group. rTMS significantly improved walking speed and stride length compared to controls. Particularly, resting motor thresholds decreased after 10 sessions of rTMS. CONCLUSIONS: rTMS improves walking speed in patients with HAM and may be an effective alternative for treating gait disturbance in patients with HAM.
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Affiliation(s)
- Nobuyuki Sasaki
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tomoo Sato
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masato Yamatoku
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihisa Yamano
- Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Rare Diseases Research, Institute of Medical Science, St. Marianna University School of Medicine, Kawasaki, Japan
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Wang S, Wang P, Yin R, Xiao M, Zhang Y, Reinhardt JD, Wang H, Xu G. Combination of repetitive transcranial magnetic stimulation and treadmill training reduces hyperreflexia by rebalancing motoneuron excitability in rats after spinal cord contusion. Neurosci Lett 2022; 775:136536. [PMID: 35183693 DOI: 10.1016/j.neulet.2022.136536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/12/2022] [Accepted: 02/15/2022] [Indexed: 11/19/2022]
Abstract
Spasticity commonly emerges during the process of recovery after spinal cord injury (SCI) and critically exacerbates motor dysfunction. Given insufficient effects of individual therapies, we combined repetitive transcranial magnetic stimulation (rTMS) with treadmill training (Tr) in rats with SCI to investigate potential synergistic effects on alleviating spasticity and motor dysfunction. Animals were randomized into four groups: SCI only, rTMS, Tr, and rTMS plus Tr. At the study endpoint eight weeks after the start of interventions, the rTMS plus Tr group exhibited the largest decrease in maximal H-reflex amplitude/maximal M-wave amplitude ratio (effect size (ES): -0.082, 95% confidence interval (CI): -0.118 to -0.046, p < 0.001) as well as the greatest improvement in motor function measured with the Basso, Beattie, and Bresnahan locomotor scale (ES: 1.811, 95% CI: 1.018 to 2.603, p < 0.001; significantly different from all other groups at p < 0.01) and grid-walking test (ES: -5.1, 95% CI: -7.784 to -2.416, p < 0.001, significantly different from rTMS alone at p < 0.01). Pathological analyses demonstrated that the combined treatment facilitated the growth of serotonergic axons around the lesion site, and the upregulation of 5-hydroxytryptamine, potassium-chloride cotransporter-2, and glutamic acid decarboxylases 67 in the lumbar spinal cord distal to the injury site. All effects of combined treatment of rTMS and treadmill training were enhanced compared to treadmill training or rTMS alone. Treadmill training and rTMS intervention appear to have synergistic effects on hyperreflexia and locomotion likely related to a restored balance between facilitatory and inhibitory inputs to motoneurons.
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Affiliation(s)
- Shuangyan Wang
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China; Nanjing Medical University, Center of Rehabilitation Medicine, 1st affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Pei Wang
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China
| | - Ruian Yin
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China
| | - Ming Xiao
- Jiangsu Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing 211166, China
| | - Yongjie Zhang
- Department of Human Anatomy, Nanjing Medical University, Nanjing 211166, China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, China
| | - Hongxing Wang
- Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University Nanjing 210024, China.
| | - Guangxu Xu
- Nanjing Medical University, Center of Rehabilitation Medicine, 1st affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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Wang P, Yin R, Wang S, Zhou T, Zhang Y, Xiao M, Wang H, Xu G. Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) and Treadmill Training on Recovery of Motor Function in a Rat Model of Partial Spinal Cord Injury. Med Sci Monit 2021; 27:e931601. [PMID: 34304239 PMCID: PMC8317583 DOI: 10.12659/msm.931601] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) and treadmill training (TT) on motor function recovery in rats with partial spinal cord injury (SCI). MATERIAL AND METHODS Sixty rats with moderate partial SCI at the 9th thoracic vertebral level induced by a Louisville Injury System Apparatus impactor were randomly allocated to 5 groups: Sham surgery (Intact); Sham rTMS without TT (S-rTMS/Non-TT); Sham rTMS with TT (S-rTMS/TT); rTMS without TT (rTMS/Non-TT); and rTMS with TT (rTMS/TT). Interventions commenced 8 days after SCI and continued for 8 weeks. Outcomes studied were Basso, Beattie, and Bresnahan locomotor scale scores, grid walking test, and biochemical analysis of the brain-derived neurotrophic factor (BDNF), synapsin I (SYN), and postsynaptic density protein-95 (PSD-95) in the motor cortex and spinal cord. RESULTS The rTMS/TT contributed to greater Basso, Beattie, and Bresnahan scores compared with the S-rTMS/Non-TT (P<0.01), S-rTMS/TT (P<0.05), and rTMS/Non-TT (P<0.05), and showed obviously reduced numbers of foot drops compared with the S-rTMS/Non-TT (P<0.05). The rTMS/TT significantly increased the expressions of BDNF, SYN, and PSD-95 compared with the S-rTMS/Non-TT, both in the motor cortex (P<0.01, P<0.01, P<0.001, respectively) and spinal cord (P<0.001, P<0.01, P<0.05, respectively). CONCLUSIONS In a modified rat model of SCI, combined rTMS with TT improved motor function, indicating that this combined approach promoted adaptive neuroplasticity between the motor cortex and the spinal cord. A combined app roach to improving motor function following SCI requires further evaluation to determine the possible clinical applications.
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Affiliation(s)
- Pei Wang
- School of Rehabilitation Medicine, Nanjing Medical University, Center of Rehabilitation Medicine, 1 affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
- Department of Rehabilitation Medicine, Jiangsu Shengze Hospital, Nanjing Medical University, Suzhou, Jiangsu, PR China
| | - Ruian Yin
- School of Rehabilitation Medicine, Nanjing Medical University, Center of Rehabilitation Medicine, 1 affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Shuangyan Wang
- School of Rehabilitation Medicine, Nanjing Medical University, Center of Rehabilitation Medicine, 1 affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Ting Zhou
- Department of Rehabilitation Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
| | - Yongjie Zhang
- Department of Human Anatomy, Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Ming Xiao
- Jiangsu Key Laboratory of Neurodegeneration, Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Hongxing Wang
- Department of Rehabilitation Medicine, Jiangsu Shengze Hospital, Nanjing Medical University, Suzhou, Jiangsu, PR China
- Department of Rehabilitation Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, PR China
| | - Guangxu Xu
- School of Rehabilitation Medicine, Nanjing Medical University, Center of Rehabilitation Medicine, 1 affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China
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Che X, Cash RFH, Luo X, Luo H, Lu X, Xu F, Zang YF, Fitzgerald PB, Fitzgibbon BM. High-frequency rTMS over the dorsolateral prefrontal cortex on chronic and provoked pain: A systematic review and meta-analysis. Brain Stimul 2021; 14:1135-1146. [PMID: 34280583 DOI: 10.1016/j.brs.2021.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND High-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) has demonstrated mixed effects on chronic and provoked pain. OBJECTIVES/METHODS In this study, a meta-analysis was conducted to characterise the potential analgesic effects of high-frequency rTMS over the DLPFC on both chronic and provoked pain. RESULTS A total of 626 studies were identified in a systematic search. Twenty-six eligible studies were included for the quantitative review, among which 17 modulated chronic pain and the remaining investigated the influence on provoked pain. The left side DLPFC was uniformly targeted in the chronic pain studies. While our data identified no overall effect of TMS across chronic pain conditions, there was a significant short-term analgesia in neuropathic pain conditions only (SMD = -0.87). In terms of long-lasting analgesia, there was an overall pain reduction in the midterm (SMD = -0.53, 24.6 days average) and long term (SMD = -0.63, 3 months average) post DLPFC stimulation, although these effects were not observed within specific chronic pain conditions. Surprisingly, the number of sessions was demonstrated to have no impact on rTMS analgesia. In the analysis of provoked pain, our data also indicated a significant analgesic effect following HF-rTMS over the DLPFC (SMD = -0.73). Importantly, we identified a publication bias in the studies of provoked pain but not for chronic pain conditions. CONCLUSIONS Overall, our findings support that HF-DLPFC stimulation is able to induce an analgesic effect in chronic pain and in response to provoked pain. These results highlight the potential of DLPFC-rTMS in the management of certain chronic pain conditions and future directions are discussed to enhance the potential long-term analgesic effects.
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Affiliation(s)
- Xianwei Che
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China.
| | - Robin F H Cash
- Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, Australia; Department of Biomedical Engineering, The University of Melbourne, Victoria, Australia
| | - Xi Luo
- Shenzhen Key Laboratory of Affective and Social Cognitive Science, School of Psychology, Shenzhen University, Shenzhen, China
| | - Hong Luo
- Children and Adolescents Mental Health Joint Clinic, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Xiaodong Lu
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Feng Xu
- Shenzhen Yingchi Technology Co., Ltd, China
| | - Yu-Feng Zang
- Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, China
| | - Paul B Fitzgerald
- Epworth Centre for Innovation in Mental Health, Epworth Healthcare and Monash University Department of Psychiatry, Victoria, Australia
| | - Bernadette M Fitzgibbon
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Australia
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12
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Marufa SA, Hsieh TH, Liou JC, Chen HY, Peng CW. Neuromodulatory effects of repetitive transcranial magnetic stimulation on neural plasticity and motor functions in rats with an incomplete spinal cord injury: A preliminary study. PLoS One 2021; 16:e0252965. [PMID: 34086836 PMCID: PMC8177618 DOI: 10.1371/journal.pone.0252965] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
We investigated the effects of intermittent theta-burst stimulation (iTBS) on locomotor function, motor plasticity, and axonal regeneration in an animal model of incomplete spinal cord injury (SCI). Aneurysm clips with different compression forces were applied extradurally around the spinal cord at T10. Motor plasticity was evaluated by examining the motor evoked potentials (MEPs). Long-term iTBS treatment was given at the post-SCI 5th week and continued for 2 weeks (5 consecutive days/week). Time-course changes in locomotor function and the axonal regeneration level were measured by the Basso Beattie Bresnahan (BBB) scale, and growth-associated protein (GAP)-43 expression was detected in brain and spinal cord tissues. iTBS-induced potentiation was reduced at post-1-week SCI lesion and had recovered by 4 weeks post-SCI lesion, except in the severe group. Multiple sessions of iTBS treatment enhanced the motor plasticity in all SCI rats. The locomotor function revealed no significant changes between pre- and post-iTBS treatment in SCI rats. The GAP-43 expression level in the spinal cord increased following 2 weeks of iTBS treatment compared to the sham-treatment group. This preclinical model may provide a translational platform to further investigate therapeutic mechanisms of transcranial magnetic stimulation and enhance the possibility of the potential use of TMS with the iTBS scheme for treating SCIs.
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Affiliation(s)
- Siti Ainun Marufa
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- Physical Therapy Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia
| | - Tsung-Hsun Hsieh
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Jian-Chiun Liou
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Yung Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Wei Peng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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13
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Feng S, Wang S, Sun S, Su H, Zhang L. Effects of combination treatment with transcranial magnetic stimulation and bone marrow mesenchymal stem cell transplantation or Raf inhibition on spinal cord injury in rats. Mol Med Rep 2021; 23:294. [PMID: 33649786 PMCID: PMC7930933 DOI: 10.3892/mmr.2021.11934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/07/2021] [Indexed: 11/07/2022] Open
Abstract
Spinal cord injury (SCI) remains a global challenge due to limited treatment strategies. Transcranial magnetic stimulation (TMS), bone marrow mesenchymal stem cell (BMSC) transplantation and downregulation of Raf/MEK/ERK signaling effectively improve SCI. The combination of BMSCs and TMS displays synergistic effects on vascular dementia. However, whether TMS displays a synergistic effect when combined with BMSC transplantation or Raf inhibitor (RafI) therapy for the treatment of SCI is not completely understood. The present study aimed to compare the therapeutic effect of monotherapy and combination therapy on SCI. In the present study, 8‑week‑old female Sprague Dawley rats were used to establish a model of SCI using the weight‑drop method followed by treatment with monotherapy (TMS, BMSCs or RafI) or combination therapy (TMS+BMSCs or TMS+RafI). The effect of monotherapy and combination therapy on locomotor function, pathological alterations, neuronal apoptosis and expression of axonal regeneration‑associated factors and Raf/MEK/ERK signaling‑associated proteins in the spinal cord was analyzed by Basso, Beattie and Bresnahan (BBB) scoring, hematoxylin and eosin staining, TUNEL‑neuronal nuclei (NeuN) staining and immunofluorescence or western blotting, respectively. The results demonstrated that compared with untreated SCI model rats, monotherapy significantly enhanced locomotor functional recovery, as evidenced by higher BBB scores, and slightly alleviated histopathological lesions of the spinal cord in SCI model rats. Furthermore, monotherapy markedly suppressed neuronal apoptosis and promoted axonal regeneration, as well as inhibiting astroglial activation in SCI model rats. The aforementioned results were demonstrated by significantly decreased numbers of apoptotic neurons, markedly decreased expression levels of glial fibrillary acidic protein (GFAP), significantly increased numbers of NeuN+ cells, markedly increased expression levels of growth‑associated protein 43 (GAP‑43) and significantly upregulated nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) expression levels in monotherapy groups (excluding the RafI monotherapy group) compared with untreated SCI model rats. In addition, monotherapy markedly suppressed activation of the Raf/MEK/ERK signaling pathway, as evidenced by significantly reduced p‑Raf/Raf, p‑MEK/MEK and p‑ERK/ERK protein expression levels in monotherapy groups (excluding the BMSC monotherapy group) compared with untreated SCI model rats. Notably, combination therapy further alleviated SCI‑induced spinal cord lesions and neuronal apoptosis, increased GAP‑43, NGF and BDNF expression levels, downregulated GFAP expression levels and inhibited activation of the Raf/MEK/ERK signaling pathway in SCI model rats compared with the corresponding monotherapy groups. Therefore, it was hypothesized that compared with monotherapy, combination therapy displayed an improved therapeutic effect on SCI by further suppressing Raf/MEK/ERK signaling. The results of the present study provided an important basis for the clinical application of combination therapy.
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Affiliation(s)
- Sining Feng
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Shuai Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Shi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Hao Su
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, P.R. China
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Hodaj H, Payen JF, Lefaucheur JP. Therapeutic impact of motor cortex rTMS in patients with chronic neuropathic pain even in the absence of an analgesic response. A case report. Neurophysiol Clin 2018; 48:303-308. [DOI: 10.1016/j.neucli.2018.05.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/21/2018] [Accepted: 05/21/2018] [Indexed: 12/17/2022] Open
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15
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Gharooni AA, Nair KPS, Hawkins D, Scivill I, Hind D, Hariharan R. Intermittent theta-burst stimulation for upper-limb dysfunction and spasticity in spinal cord injury: a single-blind randomized feasibility study. Spinal Cord 2018; 56:762-768. [DOI: 10.1038/s41393-018-0152-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/02/2018] [Accepted: 04/05/2018] [Indexed: 11/09/2022]
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The corticomotor projection to liminally-contractable forearm muscles in chronic spinal cord injury: a transcranial magnetic stimulation study. Spinal Cord 2016; 55:362-366. [PMID: 27995943 DOI: 10.1038/sc.2016.161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/22/2016] [Accepted: 09/26/2016] [Indexed: 01/03/2023]
Abstract
STUDY DESIGN A cross-sectional study in chronic spinal cord injury with cervical lesions (cSCI). OBJECTIVE To determine the corticomotor projection and motor cortex organization of paralyzed forearm muscles that presented only liminal voluntary activation. SETTING Burke Medical Research Institute, White Plains, NY, USA. METHODS We identified ten people with chronic SCI who had a wrist flexor or extensor muscle with a motor power (MP) of 1 over 5. We recorded motor evoked potentials (MEPs) to transcranial magnetic stimulation (TMS) over the primary motor cortex of the hemisphere contralateral to the target muscle. We measured resting motor threshold (RMT), corticomotor latency (LTY), MEP amplitude (AMP) and performed cortical motor mapping to determine the optimal site (OPT) and map area (AREA). Results were compared with the data from 18 controls. RESULTS A MEP in the target muscle was observed for all cSCI cases. LTY was normal, while corticomotor excitability (as determined by RMT and AMP) was reduced in about half of the group. The OPT site of the motor maps was within control range for all cSCI cases, while AREA was reduced in three cases. CONCLUSIONS Corticomotor conduction and cortical topography were appreciably normal despite only liminal activation of the target muscle with voluntary effort. Muscles with these characteristics may benefit from a targeted rehabilitation program even in the chronic phase after SCI.
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Gunduz A, Kumru H, Pascual-Leone A. Outcomes in spasticity after repetitive transcranial magnetic and transcranial direct current stimulations. Neural Regen Res 2014; 9:712-8. [PMID: 25206878 PMCID: PMC4146264 DOI: 10.4103/1673-5374.131574] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2014] [Indexed: 11/22/2022] Open
Abstract
Non-invasive brain stimulations mainly consist of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Repetitive transcranial magnetic stimulation exhibits satisfactory outcomes in improving multiple sclerosis, stroke, spinal cord injury and cerebral palsy-induced spasticity. By contrast, transcranial direct current stimulation has only been studied in post-stroke spasticity. To better validate the efficacy of non-invasive brain stimulations in improving the spasticity post-stroke, more prospective cohort studies involving large sample sizes are needed.
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Affiliation(s)
- Aysegul Gunduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Hatice Kumru
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain ; Universitat Autonoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Spain ; Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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