No abstract

Fig. 1. Bilateral deep brain stimulation (DBS) of the dentate nucleus and relation with dentatorubrothalamic tracts (DRTT). Three-dimensional depictions of electrode placement in the dentate nucleus and its relations to the dentate-rubro-thalamic tract (DRTT). Fig. 1A and B result from a co-registration of pre-operative MRI with patient-specific deterministic tractography and post-operative CT (Elements Software, Brainlab AG, Germany). Fig. 1C originates from a co-registration of pre-operative MRI and post-operative CT, however normalized to the MNI space and comparing electrode position with a normalized DRTT projection (LEAD DBS Software, Horn & Kuehn, Germany).

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Magnetic stimulation is a safe, non-invasive diagnostic tool and promising treatment strategy for neurological and psychiatric disorders. Although most studies address transcranial magnetic stimulation, transspinal magnetic stimulation (TsMS) has received recent attention since trials involving invasive spinal cord stimulation showed encouraging results for pain, spasticity, and Parkinson’s disease. While the effects of TsMS on spinal roots is well understood, its mechanism of action on the spinal cord is still controversial. Despite unclear mechanisms of action, clinical benefits of TsMS have been reported, including improvements in scales of spasticity, hyperreflexia, and bladder and bowel symptoms, and even supraspinal gait disorders such as freezing and camptocormia. In the present study, a critical review on the application of TsMS in neurology was conducted, along with an exploratory trial involving TsMS in three patients with hereditary spastic paraplegia. The goal was to understand the mechanism of action of TsMS through H-reflex measurement at the unstimulated lumbosacral level. Although limited by studies with a small sample size and a low to moderate effect size, TsMS is safe and tolerable and presents consistent clinical and neurophysiological benefits that support its use in clinical practice.