Raffaele Nardone1,2,3, Patrick B Langthaler1,3,4, Andrea Orioli2, Peter Höller1,3, Yvonne Höller1, Vanessa N Frey1,3, Francesco Brigo2,5, Eugen Trinka1,3. 1. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria. 2. Department of Neurology, Franz Tappeiner Hospital, Merano, Italy. 3. Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria. 4. Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria. 5. Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy.
Abstract
PURPOSE: Spasticity is a common disorder in patients with spinal cord injury (SCI). The aim of this study was to investigate whether intermittent theta burst stimulation (iTBS), a safe, non-invasive and well-tolerated protocol of excitatory repetitive transcranial magnetic stimulation (rTMS), is effective in modulating spasticity in SCI patients. METHODS: In this randomized, double-blind, crossover, sham-controlled study, ten subjects with incomplete cervical or thoracic SCI received 10 days ofdaily sessions of real or sham iTBS. The H/M amplitude ratio of the Soleus H reflex, the amplitude of the motor evoked potentials (MEPs) at rest and during background contraction, as well as Modified Ashworth Scale (MAS) and the Spinal Cord Injury Assessment Tool for Spasticity (SCAT) were compared before and after the stimulation protocols. RESULTS: Patients receiving real iTBS showed significant increased resting and active MEPs amplitude and a significant reduction of the H/M amplitude ratio. In these patients also the MAS and SCAT scores were significantly reduced after treatment. These changes persisted up to 1 week after the end of the iTBS treatment, and were not observed under the sham-TBS condition. CONCLUSION: These findings suggest that iTBS may be a promising therapeutic tool for the spasticity in SCI patients.
RCT Entities:
PURPOSE:Spasticity is a common disorder in patients with spinal cord injury (SCI). The aim of this study was to investigate whether intermittent theta burst stimulation (iTBS), a safe, non-invasive and well-tolerated protocol of excitatory repetitive transcranial magnetic stimulation (rTMS), is effective in modulating spasticity in SCI patients. METHODS: In this randomized, double-blind, crossover, sham-controlled study, ten subjects with incomplete cervical or thoracic SCI received 10 days of daily sessions of real or sham iTBS. The H/M amplitude ratio of the Soleus H reflex, the amplitude of the motor evoked potentials (MEPs) at rest and during background contraction, as well as Modified Ashworth Scale (MAS) and the Spinal Cord Injury Assessment Tool for Spasticity (SCAT) were compared before and after the stimulation protocols. RESULTS:Patients receiving real iTBS showed significant increased resting and active MEPs amplitude and a significant reduction of the H/M amplitude ratio. In these patients also the MAS and SCAT scores were significantly reduced after treatment. These changes persisted up to 1 week after the end of the iTBS treatment, and were not observed under the sham-TBS condition. CONCLUSION: These findings suggest that iTBS may be a promising therapeutic tool for the spasticity in SCI patients.
Authors: Aref-Ali Gharooni; Brian K Kwon; Michael G Fehlings; Timothy F Boerger; Ricardo Rodrigues-Pinto; Paul Aarne Koljonen; Shekar N Kurpad; James S Harrop; Bizhan Aarabi; Vafa Rahimi-Movaghar; Jefferson R Wilson; Benjamin M Davies; Mark R N Kotter; James D Guest Journal: Global Spine J Date: 2022-02