Omitting TMS component from paired associative stimulation with high-frequency PNS: A case series of tetraplegic patients

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Pohjonen , M , Savolainen , S , Arokoski , J & Shulga , A 2021 , ' Omitting TMS component from paired associative stimulation with high-frequency PNS: A case series of tetraplegic patients ' , Clinical neurophysiology practice , vol. 6 , pp. 81-87 . https://doi.org/10.1016/j.cnp.2021.01.004

Title: Omitting TMS component from paired associative stimulation with high-frequency PNS: A case series of tetraplegic patients
Author: Pohjonen, Markus; Savolainen, Sarianna; Arokoski, Jari; Shulga, Anastasia
Contributor organization: HUS Medical Imaging Center
Helsinki University Hospital Area
BioMag Laboratory
University of Helsinki
HUS Internal Medicine and Rehabilitation
Clinicum
HUS Neurocenter
Department of Neurosciences
Neurologian yksikkö
Date: 2021-02-20
Language: eng
Number of pages: 7
Belongs to series: Clinical neurophysiology practice
ISSN: 2467-981X
DOI: https://doi.org/10.1016/j.cnp.2021.01.004
URI: http://hdl.handle.net/10138/333613
Abstract: Objectives: Earlier studies have shown how chronic spinal cord injury (SCI) patients have benefitted from paired associative stimulation (PAS), consisting of high-frequency peripheral nerve stimulation (PNS) and high-intensity transcranial magnetic stimulation (TMS). Since high-frequency PNS is poorly characterized, its therapeutic effect without TMS should be evaluated. We tested the effect of PNS combined with motor imagery in chronic SCI patients using the same parameters of PNS as in earlier PAS-based studies that also used TMS. Methods: Five patients with chronic incomplete SCI and tetraplegia received a 6-week treatment of PNS combined with motor imagery to the weaker upper limb. Patients were evaluated with Manual Muscle Testing (MMT), hand function tests (Box and block, grip and pinch strength dynamometry), and spasticity. Results: There was no significant change in hand function tests or spasticity. MMT values improved significantly immediately after the PNS period (0.59 +/- 0.17, p = 0.043) and in the 1-month follow-up visit (0.87 +/- 0.18, p = 0.043). However, improvement of MMT values was weaker than in chronic tetraplegic patients in a corresponding PAS study that used identical PNS stimulation but also included the TMS component omitted here (Tolmacheva et al., 2019a, Clin Neurophysiol Pract). Conclusions: The lack of effect on functional hand tests with the protocol presented here suggests that the synergistic effect of PNS and TMS components is essential for the full therapeutic effect previously observed with PAS intervention. The moderate improvement of the MMT score suggests the possible usefulness of PNS and motor imagery for some of those tetraplegic SCI patients who have contraindications to TMS. Significance: These results add to the understanding of the PAS therapeutic mechanism by highlighting the importance of dual stimulation for achieving the full therapeutic effect of long-term PAS with a high-frequency PNS component. (C) 2021 International Federation of Clinical Neurophysiology. Published by Elsevier B.V.
Subject: 3112 Neurosciences
3124 Neurology and psychiatry
Peripheral nerve stimulation
Paired Associative Stimulation
Rehabilitation
Spinal Cord
Spinal cord injury
SPINAL-CORD-INJURY
PERIPHERAL-NERVE STIMULATION
MOTOR CORTEX
RELIABILITY
PLASTICITY
GUIDELINES
INDUCTION
THERAPY
BRAIN
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: publishedVersion


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