title: Effects of high-frequency repetitive transcranial magnetic stimulation on motor and gait improvement in incomplete spinal cord injury patients.
abstract: OBJECTIVE
  Incomplete spinal cord injury (SCI) patients have the potential to regain some ambulatory function, and optimal reorganization of remaining circuits can contribute to this recovery. We hypothesized that repetitive transcranial magnetic stimulation (rTMS) may promote active recovery of motor function during gait rehabilitation.
  
  
  METHODS
  A total of 17 incomplete SCI patients were randomized to receive active rTMS or sham stimulation coupled with rehabilitation therapy; 3 patients who began in the sham group crossed over to the active rTMS group after a washout period of more than 3 weeks. Active rTMS consisted of 15 daily sessions over the leg motor area (at 20 Hz). We compared lower-extremity motor score (LEMS), 10-m walking test for walking speed, timed up and go, Walking Index for SCI Scale, Modified Ashworth Scale, and Spinal Cord Injury Spasticity Evaluation Tool at baseline, after the last session, and 2 weeks later in the active rTMS and sham stimulation groups.
  
  
  RESULTS
  A significant improvement was observed after the last rTMS session in the active group for LEMS, walking speed, and spasticity. Improvement in walking speed was maintained during the follow-up period. Sham stimulation did not induce any improvement in LEMS, gait assessment, and spasticity after the last session and neither during follow-up.
  
  
  CONCLUSIONS
  In incomplete SCI, 15 daily sessions of high-frequency rTMS can improve motor score, walking speed, and spasticity in the lower limbs. The study provides evidence for the therapeutic potential of rTMS in the lower extremities in SCI rehabilitation.
authors: Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain. hkumru@guttmann.com
authors: Hatice
authors: H
authors: Kumru
authors: Jesus
authors: J
authors: Benito
authors: Narda
authors: N
authors: Murillo
authors: Josep
authors: J
authors: Valls-Sole
authors: Margarita
authors: M
authors: Valles
authors: Raquel
authors: R
authors: Lopez-Blazquez
authors: Ursula
authors: U
authors: Costa
authors: Josep M
authors: JM
authors: Tormos
authors: Alvaro
authors: A
authors: Pascual-Leone
authors: Joan
authors: J
authors: Vidal
mesh_terms: D000293:Adolescent; D000328:Adult; D004311:Double-Blind Method; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007717:Knee / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D013119:Spinal Cord Injuries / Q000150:complications / Q000628:therapy*; D013223:Statistics as Topic; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055815:Young Adult
keywords: functional improvement; incomplete SCI; rehabilitation; transcranial magnetic stimulation