Reactivating Residual Motor Circuits in Complete Spinal Cord Injury Through Mode- and Site-Specific Transcranial Magnetic Stimulation: A Pilot Randomized Controlled Trial

In 37 people with thoracolumbar AIS-A complete spinal cord injury (<3 months post injury), iTBS targeting motor cortex increased Lower Extremity Motor Score and improved WISCI II.

• Why it matters: Motor recovery after complete spinal cord injury is limited, and it is unclear which transcranial stimulation mode and site best supports neuroplasticity and functional gains.
• What they did: In a double-blind randomized pilot trial, 30 participants completing follow-up (n=6 per group) received 2 TMS sessions/day for 5 days with standardized rehabilitation across sham, motor cortex rTMS, motor cortex iTBS, spinal cord iTBS, or combined motor cortex plus spinal cord iTBS.
• The result: Motor cortex iTBS and motor cortex+spinal cord iTBS increased LEMS (p<0.05) and improved WISCI II; LEMS correlated with WISCI (R=0.60, p=0.0019) and with MEP amplitude (R=0.49, p=0.014), while correlating negatively with pNF (R=0.54, p=0.0006).

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