nTMS in spinal cord injury: Current evidence, challenges and a future direction

Spinal Cord Injury (SCI) has devastating consequences for patients and their families. Over the last few decades, a renewed interest in the utilization of non-invasive and cost-effective therapeutic technologies in the management of patients with SCI has emerged. This includes stimulation with navigated transcranial magnetic stimulation (nTMS) in order to improve the outcome for these patients alongside with existing clinical tools. nTMS has shown encouraging preliminary results in both clinical assessment and rehabilitation (motor and pain) of patients with SCI. However, different protocols – stimulation parameters, length of treatment and combination with other modalities – and patient selection criteria hampered definitive conclusions. So far, none of these have been adapted in regular clinical practice. In this article, we provide an overview on different assessment and therapeutic strategies using nTMS and review their effectiveness.