title: rTMS modulates reciprocal inhibition in patients with traumatic spinal cord injury.
abstract: METHODS
  Randomized, double-blind, crossover, sham-controlled trial.
  
  
  OBJECTIVE
  Repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) leads to a significant reduction of spasticity in subjects with spinal cord injury (SCI), but the physiological basis of this effect is still not well understood. The purpose of this study was to evaluate the disynaptic reciprocal Ia inhibition of soleus motoneurons in SCI patients.
  
  
  METHODS
  Department of Neurology, Merano, Italy and TMS Laboratory, Paracelsus Medical University, Salzburg, Austria.
  
  
  METHODS
  Nine subjects with incomplete cervical or thoracic SCI received 5 days of daily sessions of real or sham rTMS applied over the contralateral M1. We compared the reciprocal inhibition, the Modified Ashworth Scale and the Spinal Cord Injury Assessment Tool for Spasticity at baseline, after the last session and 1 week later in the real rTMS and sham stimulation groups.
  
  
  RESULTS
  We found that real rTMS significantly reduced lower limb spasticity and restored the impaired excitability in the disynaptic reciprocal inhibitory pathway.
  
  
  CONCLUSIONS
  In a small proof-of-concept study, rTMS strengthened descending projections between the motor cortex and inhibitory spinal interneuronal circuits. This reversed a defect in reciprocal inhibition after SCI, and reduced leg spasticity.
authors.affiliation: 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.
authors.forename: R
authors.initials: R
authors.lastname: Nardone
authors.affiliation: 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Y
authors.initials: Y
authors.lastname: Höller
authors.affiliation: 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Thomschewski
authors.affiliation: 1] Department of Neurology, Franz Tappeiner Hospital, Merano, Italy [2] Department of Neurological, Neuropsychological, Morphological and Movement Sciences. Section of Clinical Neurology, University of Verona, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Brigo
authors.affiliation: Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Orioli
authors.affiliation: 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Höller
authors.affiliation: 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Golaszewski
authors.affiliation: 1] Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria [2] Spinal Cord Injury and Tissue Regeneration Center, Paracelsus Medical University, Salzburg, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Trinka
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D006181:H-Reflex / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009046:Motor Neurons / Q000502:physiology; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D018482:Muscle, Skeletal / Q000473:pathology; D009433:Neural Inhibition / Q000502:physiology* / Q000528:radiation effects; D040921:Stress Disorders, Traumatic / Q000150:complications / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D015599:Trauma Severity Indices