Translating a Preclinically Tested 15 Hz rTMS Protocol to Humans With Chronic Spinal Cord Injury: A Safety and Feasibility Study.

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Nabila Brihmat, Mehmed B Bayram, Morgan Paine, Janelle Carnahan, Jian Zhong, Xiaofei Guan, Guang H Yue, Soha Saleh, Gail F Forrest
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Abstract

Objectives: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation strategy with a demonstrated potential to reinforce the residual pathways after a spinal cord injury (SCI). A preclinically tested high-frequency (15 Hz) rTMS (15 Hz rTMS) protocol was shown to induce corticospinal tract axon regeneration growth and sprouting, resulting in improved voluntary motor control and performance. In a translational perspective, we aimed to investigate the safety and feasibility of the 15 Hz rTMS paradigm as an adjunct therapeutic intervention in individuals with chronic SCI.

Method: We thus investigated the effects of a 15-day repeated protocol consisting of 15 Hz rTMS followed by task-specific hand motor training in 7 individuals with chronic cervical SCI. 15 Hz rTMS targeted the weaker wrist extensor muscle, based on participant- and day-specific resting motor threshold, motor responses, and maximum tolerability. Safety, feasibility, neurophysiological, and clinical functional outcomes were measured at different times of the therapeutic protocol.

Results: The therapeutic stimulation protocol was delivered mostly as designed except with regard to stimulation intensity and duration and was overall tolerable without major serious effects. Preliminary neuroplastic and functional benefits revealed by corticospinal excitability and intracortical inhibition modulation and clinical improvements were noted and were still observable at follow-up times.

Interpretation: This study confirms that an intervention combining 15 Hz rTMS and task-specific motor training is feasible, tolerable, and has the potential to induce neuroplastic changes and improve function in individuals with chronic cervical SCI. This feasibility study, in parallel with previous reports in able-bodied individuals, warrants further investigation of the adapted 15 Hz rTMS protocol in individuals at an earlier stage post-injury and to confirm efficacy in a larger and controlled study trial.

将临床前测试的15赫兹rTMS方案转化为慢性脊髓损伤患者:安全性和可行性研究。
目的:重复经颅磁刺激(rTMS)是一种非侵入性脑刺激策略,具有增强脊髓损伤(SCI)后残留通路的潜力。临床前测试的高频(15 Hz) rTMS (15 Hz rTMS)方案显示可诱导皮质脊髓束轴突再生生长和发芽,从而改善自主运动控制和表现。从转化的角度来看,我们旨在研究15hz rTMS范式作为慢性脊髓损伤患者辅助治疗干预的安全性和可行性。方法:我们对7例慢性颈椎损伤患者进行了15天的重复性方案,包括15 Hz rTMS和特定任务的手部运动训练。15hz rTMS基于参与者和特定一天的静息运动阈值、运动反应和最大耐受性,针对较弱的腕伸肌。在治疗方案的不同时间测量安全性、可行性、神经生理学和临床功能结果。结果:除刺激强度和持续时间外,治疗性刺激方案基本符合设计,总体上可耐受,无重大严重影响。皮质脊髓兴奋性和皮质内抑制调节以及临床改善显示了初步的神经可塑性和功能益处,并且在随访时仍然可以观察到。解释:本研究证实,结合15hz rTMS和任务特异性运动训练的干预是可行的,可耐受的,并且有可能诱导慢性颈椎脊髓损伤患者的神经可塑性改变和改善功能。这项可行性研究,与之前在健全个体中进行的报告同时进行,值得在损伤后早期阶段进一步研究改编的15hz rTMS方案,并在更大的对照研究试验中证实其有效性。
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来源期刊
Annals of Clinical and Translational Neurology
Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)
CiteScore
9.10
自引率
1.90%
发文量
218
审稿时长
8 weeks
期刊介绍: Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.
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