Effectiveness of Repetitive Transcranial Magnetic Stimulation Combined with Transspinal Electrical Stimulation on Corticospinal Excitability for Individuals with Incomplete Spinal Cord Injury: A Pilot Study

Abstract

Abstract Repetitive Transcranial Magnetic Stimulation (rTMS) and transspinal electrical stimulation (tsES) have been proposed as a novel neurostimulation modality for individuals with incomplete spinal cord injury (iSCI). In this study, we integrated magnetic and electrical stimulators to provide neuromodulation therapy to individuals with iSCI. We then designed a clinical trial comprising an 8-week treatment period and a 4-week treatment-free observation period. Assessments of cortical excitability, clinical features, inertial measurement unit and surface electromyography were conducted every 4 weeks. Twelve individuals with iSCI were recruited and randomly divided into a combined therapy group, a magnetic stimulation group, an electrical stimulation group, or a sham stimulation group. The magnetic and electric stimulations provided in this study were intermittent theta-burst stimulation (iTBS) and 2.5-mA direct current (DC) stimulation, respectively. According to the results, combined therapy, which involves iTBS and transspinal DC stimulation (tsDCS), was more effective than was iTBS alone or tsDCS alone in terms of increasing corticospinal excitability. In addition, the effectiveness of 8-week combined therapy in increasing corticospinal excitability faded 4 weeks after the cessation of treatment. Although promising, the results of this study must be validated by studies with longer interventions and larger sample sizes.