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Prof. Dr. Cengiz BAHADIR

Spinal Cord Injuries

Transcranial Magnetic Stimulation in Spinal Cord Injuries

Spinal cord is a highly complex structure composed of axons (white matter) of neurons in the brain and neuron bodies of spine (grey matter). Its primary function is to exchange information between the brain and the body, to transmit movement orders and to manage reflexes. In spite of its svelte structure, it plays role in countless physiological phenomenons. Its most important function is to transmit movement orders to the extremities. In the case of a spinal cord injury, these functions are partially or fully impaired, leading to paraplegia.
Paraplegia is examined in two groups: In the first group, the lesions under thoracic spine causes paralysis only on the legs (paraplegia) while in the second group, the lesions above that level causes paralysis both on the arms and legs (tetraplegia). Depending on the scope of the injury (partially or fully), these can also be categorized as complete or incomplete spinal cord injuries. Spinal cord injuries are one of the most significant fields of work in rehabilitation medicine and these cases are very common both in our country and the world. The most common reason is trauma with traffic accidents leading the way Cases of falling follow this.
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Spinal cord injury is a very serious clinical picture. Depending on the severity of the injury, the patient suffers from paraplegia and many complications of paraplegia. The more severe the injury, the more severe the paraplegia and its complications. These patients develop many complications such as unusual stiffness on the muscles defined as spasticity, bedsores, being unable to void, osteoporosis. There are some studies conducted to accelerate recovery and minimize side effects for patients with spinal cord injuries. There have been many experiments including stem cell therapy. Recently, transcranial magnetic stimulation (TMS) therapy has been preferred for the management of patients with spinal cord injuries. TMS treatment is based on external stimulation of neurons with magnetic field. This is performed via magnetic current directed through a coil connected to the magnetic stimulation device. It includes near zero side effects. The therapy stimulates or suppresses the relevant site depending on the frequency.
Due to this specification, TMS therapy is used for prediction of prognosis on patients with spinal cord injuries. It is possible to detect if the orders from the cells responsible of movement are transmitted to the extremities at all or if they are transmitted, to which extent. TMS therapy provides valuable insight about the impact of the injury on the spinal cord and to what extent it can be cured (MEP test: Motor Evoked Potentials).
Another intended use of TMS is to accelerate post-injury sensory and motor (motion) recovery for such patients. Two of the 3 studies conducted on this matter have shown that delivering stimulation at high frequency to the cortex area related to the feet provides significant improvement on motor recovery and ability to walk (in incomplete cases). There are many researches being conducted in this matter. TMS therapy is also experimented for the treatment of spasticity (unusual stiffness on the muscles). Positive outcomes have been achieved upon delivering stimulation at high frequency to motor cortex. Recently developed active assistive robot systems (exoskeletal) have been experimented on patients with spinal cord injuries. Spasticity is one of the most significant obstacles for the use of these systems. According to estimations, TMS therapy will facilitate the use of these systems by the patients in the coming years.

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One of the most significant complications regarding spinal cord injuries is pain and in some cases, it may evolve into the destructive neuropathic pain. TMS stands out with its use in the treatment of such neuropathic pain. As per the outcomes of all the studies, TMS therapy with stimulation at high frequency provides efficacy on the treatment of neuropathic pain.
TMS has only been recently used on the treatment of complications and cases of paralysis due to spinal cord injuries. According to the studies conducted, new TMS therapy protocols will provide much better outcomes on the treatment of both the disease and complications.