Effects of paired stimulation with specific waveforms on cortical and spinal plasticity in subjects with a chronic spinal cord injury

Muhammad Adeel; Chien-Hung Lai; Bor-Shing Lin; Wing P Chan; Jian-Chiun Liou; Chun-Wei Wu; Chih-Wei Peng

doi:10.1016/j.jfma.2022.02.016

Effects of paired stimulation with specific waveforms on cortical and spinal plasticity in subjects with a chronic spinal cord injury

J Formos Med Assoc. 2022 Oct;121(10):2044-2056. doi: 10.1016/j.jfma.2022.02.016. Epub 2022 Mar 8.

Authors

Muhammad Adeel¹, Chien-Hung Lai², Bor-Shing Lin³, Wing P Chan⁴, Jian-Chiun Liou¹, Chun-Wei Wu⁵, Chih-Wei Peng⁶

Affiliations

¹ School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
² Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.
³ Department of Computer Science and Information Engineering, National Taipei University, New Taipei City, Taiwan.
⁴ Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
⁶ School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan. Electronic address: cwpeng@tmu.edu.tw.

PMID: 35277321
DOI: 10.1016/j.jfma.2022.02.016

Abstract

Background/purpose: Paired stimulation can cause neuroplasticity in corticospinal and spinal pathways in subjects with a chronic spinal cord injury (SCI). We aimed to know the effects of different waveforms using paired stimulations with bicycling in subjects with a chronic SCI.

Methods: Recruited subjects with an SCI underwent three treatment interventions in random order for 4-20 min followed by 30 min of bicycling (control, repetitive transcranial magnetic stimulation (TMS; rTMS) at 20 Hz with transspinal direct current stimulation (tsDCS), and intermittent theta burst stimulation (iTBS) with tsDCS with a 1-week gap period. A TMS method was employed to record the resting motor threshold (RMT), the 90% values of which was used as the stimulation intensity, and the Hoffman (H)-reflex was measured by stimulating the tibial nerve in the popliteal fossa. The RMT, motor evoked potential (MEP) latency, MEP peak-to-peak amplitude, and H-reflex latency as primary variables and lower extremity motor scale (LEMS) and modified Ashworth spasticity scale (MAS) as secondary variables were analyzed before and after the interventions.

Results: The MEP latency, MEP amplitude, and LEMS significantly improved with the rTMS-iTBS/tsDCS or the rTMS-20 Hz/tsDCS (p < 0.050) protocols compared to the control intervention. All other outcome measures, including RMT, H-reflex latency, and MAS score showed some changes but did not fully attain a level of significance.

Conclusion: The paired stimulation with rTMS-iTBS/tsDCS was equally effective to produce neuroplastic effect in subjects with chronic SCI compared to the conventional TMS-20 Hz/tsDCS intervention.

Keywords: Motor evoked potential (MEP); Paired stimulation (PS); Repetitive transcranial magnetic stimulation (rTMS); Spinal cord injury (SCI); Transspinal direct current stimulation (tsDCS).

MeSH terms

Brain
Evoked Potentials, Motor* / physiology
Humans
Lower Extremity
Spinal Cord
Spinal Cord Injuries* / therapy
Transcranial Magnetic Stimulation / methods