Conducted at the BioMag laboratory at the Helsinki University Hospital, a new patient study could open a new opportunity to rehabilitate patients with spinal cord damage.
Anastasia Shulga, M.D. is a neurologist who led the study, in which, according to the July 17, 2016 news release, “two patients with spinal cord injuries received a form of treatment that combined transcranial magnetic stimulation with simultaneous peripheral nerve stimulation given repeatedly for nearly six months. This was the first time that attempts were made to rehabilitate patients paralysed as a result of a spinal cord injury through long-term stimulation treatment of this type…. After approximately six months of the stimulation treatment, the paraplegic patient could bend both ankles, and the tetraplegic could grasp an object.”
“We observed strengthened neural connections and partial restoration of movement to muscles which the patients were previously entirely unable to use, ” explained Dr. Shulga.
Dr. Jyrki Mäkelä, head of the BioMag laboratory, stated, “This is a case study with two patients only, but we think the results are promising. Further study is needed to confirm whether long-term paired associative stimulation can be used in rehabilitation after spinal cord injury by itself and, possibly, in combination with other therapeutic strategies.”
Jyrki Mäkelä told OTW, “Paired associative stimulation was first developed in the laboratory of Joseph Classen, Germany, in 2000. Since then, the technique has been extensively studied in healthy subjects and has been many times shown to induce plastic changes in human corticospinal tract. However, data on the use of this non-invasive technique in neurological patients is scarce, and no work on its long-term use in spinal cord injury patients has been published before. The settings used in this study differ from the ones traditionally used in paired associative stimulation experiments. However, the equipment utilized in this project is readily available in many hospitals around the world, and thus could be feasible to set up in many places.”
“We were surprised to find out that we were able to induce such clear plasticity also in the chronic phase after the injury. Usually the strongest plasticity changes occur in the subacute phase. We were also positively surprised about the resilience and high level of cooperation of our patients, particularly at the initial phase of the experiments when no clear positive changes were observed.”
“We will continue working on the project at BioMag laboratory at Helsinki University Central Hospital. The BioMag research laboratory is operated jointly by the University of Helsinki, the Helsinki University Central Hospital and Aalto University in conjunction with the HUCH [The Hospital District of Helsinki and Uusimaa] Medical Imaging Centre on the Meilahti Campus. We will continue the work in spinal cord injury patients, as well as conduct work in healthy volunteers in attempt to optimize the settings of the protocol. Many questions are still to be answered:
- Which type of patients would benefit from the treatment, what would be the optimal duration of the treatment,
- To which extent could the neurological improvement continue if the stimulation is continued,
- As long as the improvement is observed, would the technique be helpful in combination with other approaches aimed at spinal cord repair,
- Which factors affect the persistence of the effect, and
- What is the exact role of transcranial magnetic stimulation and peripheral stimulation components in the observed improvement induced by the dual stimulation.
Among others.”
