Table 2.
Summary of clinical trials on the efficacy of TMS for treating SCI-induced complications.
| Levels of SCI | ASIA scale | Sample size | TMS stimulated region | TMS protocol | Treatment cycle | Key outcomes | Reference | ||
|---|---|---|---|---|---|---|---|---|---|
| Frequency | Intensity | Number of pulses | |||||||
| Motor dysfunction | |||||||||
| C5 | D | 4 | Left motor cortex | Double pulses (0.1 Hz/10 Hz) | 90% threshold | 360 doublet pulses | 10 days | RTMS can alter cortical inhibition in incomplete SCI and improve the clinical and functional outcomes | (59) |
| C4–T12 | D | 7 | Leg motor area of brain | 20 Hz | 90%RMT | 1,800 | 3 weeks | High-frequency rTMS can improve spasticity, motor function, and gait in motor incomplete SCI | (60) |
| C2–L2 | A–D | 11 | Bilateral leg motor cortex | 20 Hz | 100% RMT | 1,800 | 4 weeks | Great improvement in lower limb MVC and LEMS in rTMS group | (35) |
| C2–T11 | B–D | 9 | Vertex of brain | ① rTMS-20 Hz ② rTMS-iTBS | 90% RMT | ① 1,600 ② 600 | 1 day | Paired stimulation in both groups significantly improved MEP latency, MEP amplitude, and LEMS in chronic SCI subjects | (65) |
| C–D | C–D | 110 | ① M1 ② L3/L4 | 10 Hz | 100% RMT | 1,000 | 4 weeks | Clinical study protocol, no results | (67) |
| Neuropathic pain | |||||||||
| C1–T4 | A–D | 16 | Hand/leg M1 area | 90% RMT | 2,000 | 1 day | RTMS applied over the hand or leg motor cortex decreased NP | (68) | |
| C3–L1 | A–D | 14 | Left M1 | 10 Hz | 80% RMT | 1,200 | 6 weeks | High-frequency rTMS effectively enhances the analgesic effects on neuropathic pain after SCI | (69) |
| C4–L5 | A–D | 24 | Hand area of M1 | 10 Hz | 90% RMT | 1,500 | 3 weeks | rTMS relieves acute neuropathic pain in patients with SCI | (70) |
| C5–T10 | A–D | 6 | PMC DLPFC | 10 Hz | 120% RMT | 1,250 | 2 weeks | RTMS may be effective in alleviating NP in SCI patients | (71) |
| NP | / | 18 | M1 | 5 Hz | 90% RMT | 500 | 10 days | Pain was significantly improved after deep rTMS with H-coil | (72) |
| NP | / | 50 | M1 DLPFC | 10 Hz | 115% RMT | 1,250 | 4 weeks | Clinical study Protocol, no results | (73) |
| Spasticity | |||||||||
| C4–T12 | C–D | 14 | Left primary motor cortex | 20 Hz | 90% RMT | 1,600 | 5 days | rTMS improved spasticity in patients with incomplete SCI, and MAS and MPSFS were significantly reduced | (74) |
| C5–T8 | C–D | 10 | M1 (leg area) | iTBS | 0% AMT | 600 | 10 days | Resting and active MEP amplitudes were significantly increased and spasticity was reduced in SCI patients | (75) |
| C5–T10 | C–D | 8 | Left M1 | 20 Hz | 90% RMT | 1,600 | 5 days | rTMS can decrease lower limb spasticity and restore impaired excitability in the disynaptic reciprocal inhibitory pathway | (76) |
SCI, spinal cord injury; ASIA, American Spinal Injury Association; TMS, transcranial magnetic stimulation; rTMS, repetitive transcranial magnetic stimulation; RMT, resting motor threshold; MAS, modified Ashworth scale; MVC, maximal muscle strength; LEMS, lower extremities motor score; MEP, motor-evoked potential; M1, primary motor cortex; NP, neuropathic pain; PMC, premotor cortex; DLPFC, dorsolateral prefrontal cortex; MAS, modified Ashworth scale; MPSFS, modified Penn Spasm frequency scale; iTBS, intermittent theta burst stimulation; AMT, active motor threshold.