Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review
IntroductionTranscutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), altern...
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Frontiers Media S.A.
2024-03-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2024.1372222/full |
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| author | Shirin Tajali Gustavo Balbinot Gustavo Balbinot Gustavo Balbinot Maureen Pakosh Dimitry G. Sayenko Jose Zariffa Jose Zariffa Jose Zariffa Jose Zariffa Kei Masani Kei Masani |
| author_facet | Shirin Tajali Gustavo Balbinot Gustavo Balbinot Gustavo Balbinot Maureen Pakosh Dimitry G. Sayenko Jose Zariffa Jose Zariffa Jose Zariffa Jose Zariffa Kei Masani Kei Masani |
| author_sort | Shirin Tajali |
| collection | DOAJ |
| description | IntroductionTranscutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level.MethodsThe following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included.ResultsNineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor.DiscussionThis review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations. |
| first_indexed | 2024-04-24T19:24:08Z |
| format | Article |
| id | doaj.art-51d0557c57cd416ea4926bf537dd1986 |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-04-24T19:24:08Z |
| publishDate | 2024-03-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neuroscience |
| spelling | doaj.art-51d0557c57cd416ea4926bf537dd19862024-03-25T16:15:05ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2024-03-011810.3389/fnins.2024.13722221372222Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic reviewShirin Tajali0Gustavo Balbinot1Gustavo Balbinot2Gustavo Balbinot3Maureen Pakosh4Dimitry G. Sayenko5Jose Zariffa6Jose Zariffa7Jose Zariffa8Jose Zariffa9Kei Masani10Kei Masani11KITE Research Institute – University Health Network, Toronto, ON, CanadaKITE Research Institute – University Health Network, Toronto, ON, CanadaKrembil Research Institute, University Health Network, Toronto, ON, CanadaCenter for Advancing Neurotechnological Innovation to Application – CRANIA, University Health Network, Toronto, ON, CanadaLibrary & Information Services, University Health Network, Toronto Rehabilitation Institute, ON, CanadaDepartment of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United StatesKITE Research Institute – University Health Network, Toronto, ON, CanadaEdward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, CanadaInstitute of Biomedical Engineering, University of Toronto, Toronto, ON, CanadaRehabilitation Sciences Institute, University of Toronto, Toronto, ON, CanadaKITE Research Institute – University Health Network, Toronto, ON, CanadaInstitute of Biomedical Engineering, University of Toronto, Toronto, ON, CanadaIntroductionTranscutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level.MethodsThe following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included.ResultsNineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor.DiscussionThis review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.https://www.frontiersin.org/articles/10.3389/fnins.2024.1372222/fulltranscutaneous spinal cord stimulationspinal cord injuryneuroplasticityspinal excitabilitysupraspinal excitability |
| spellingShingle | Shirin Tajali Gustavo Balbinot Gustavo Balbinot Gustavo Balbinot Maureen Pakosh Dimitry G. Sayenko Jose Zariffa Jose Zariffa Jose Zariffa Jose Zariffa Kei Masani Kei Masani Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review Frontiers in Neuroscience transcutaneous spinal cord stimulation spinal cord injury neuroplasticity spinal excitability supraspinal excitability |
| title | Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review |
| title_full | Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review |
| title_fullStr | Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review |
| title_full_unstemmed | Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review |
| title_short | Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review |
| title_sort | modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury a systematic review |
| topic | transcutaneous spinal cord stimulation spinal cord injury neuroplasticity spinal excitability supraspinal excitability |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2024.1372222/full |
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