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Neurotherapeutics. 2018 Jul;15(3):618-627. doi: 10.1007/s13311-018-0639-y.

Targeted-Plasticity in the Corticospinal Tract After Human Spinal Cord Injury.

Author information

1
Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, FL, 33136, USA.
2
Bruce W. Carter Department of Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL, 33125, USA.
3
Department of Neurological Surgery, The Miami Project to Cure Paralysis, University of Miami, Miami, FL, 33136, USA. perezmo@miami.edu.
4
Bruce W. Carter Department of Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL, 33125, USA. perezmo@miami.edu.

Abstract

Spinal cord injury (SCI) often results in impaired or absent sensorimotor function below the level of the lesion. Recent electrophysiological studies in humans with chronic incomplete SCI demonstrate that voluntary motor output can be to some extent potentiated by noninvasive stimulation that targets the corticospinal tract. We discuss emerging approaches that use transcranial magnetic stimulation (TMS) over the primary motor cortex and electrical stimulation over a peripheral nerve as tools to induce plasticity in residual corticospinal projections. A single TMS pulse over the primary motor cortex has been paired with peripheral nerve electrical stimulation at precise interstimulus intervals to reinforce corticospinal synaptic transmission using principles of spike-timing dependent plasticity. Pairs of TMS pulses have also been used at interstimulus intervals that mimic the periodicity of descending indirect (I) waves volleys in the corticospinal tract. This data, along with information about the extent of the injury, provides a new framework for exploring the contribution of the corticospinal tract to recovery of function following SCI.

KEYWORDS:

Noninvasive brain stimulation; Physiology of magnetic stimulation; Rehabilitation; Spinal cord injury; Spinal plasticity.

PMID:
29946981
PMCID:
PMC6095776
DOI:
10.1007/s13311-018-0639-y
[Indexed for MEDLINE]
Free PMC Article

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