Utility of transcranial magnetic stimulation in the assessment of spinal cord injury: Current status and future directions.
Tarun Arora, Naaz Desai, Steven Kirshblum and 1 others
PMID 36275924WHAT IT FOUND
TMS can objectively measure corticospinal connectivity and silent periods in spinal cord injury, detecting residual function missed by clinical exams.
However, inconsistent findings, high measurement error, and unknown clinical meaning limit its current use for guiding individual therapy.
Key findings
01TMS can detect motor evoked potentials in muscles with no detectable voluntary function, identifying residual connectivity in clinically complete injuries.
02TMS measures correlate with clinical severity and gait scores, but inconsistencies in findings across studies and high smallest detectable change values limit their use as individual biomarkers.
03The clinical meaningful difference of TMS metrics has not been established for individuals with spinal cord injury.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review notes substantial discrepancies in TMS findings across studies, such as delayed versus non-delayed MEP latencies and smaller versus larger amplitudes. Methodological variability, including differences in coil types, orientations, and stimulation intensities, contributes to inconsistent results. Population factors like early muscle fatigue and the use of antispastic medications can affect TMS measures. The smallest detectable change for TMS measures is high, making it difficult to use them as individual biomarkers for tracking progress. The clinically meaningful difference for TMS metrics in individuals with SCI has not been established. Only a few studies have investigated the psychometric properties of TMS-based measures in the SCI population.
Declared interests
No specific funding sources or author conflicts of interest are reported in the provided text.
The easy way to misread this
Do not interpret the detection of residual connectivity via TMS as evidence that a patient will recover motor function or respond to a specific therapy. The review states that the clinical meaningful difference of TMS metrics is not established, and high measurement error limits their current utility for individual patient management.