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Thread: Transcranial Magnetic Stimulation (TMS) and Pulsed Electro-Magnetic Field (PEMF)

  1. #1

    Transcranial Magnetic Stimulation (TMS) and Pulsed Electro-Magnetic Field (PEMF)

    I received this via email, posting it here so Dr. Young can answer-


    Just over a year ago, my husband had a huge herniated disk, which compressed his spinal cord. After surgery, he had both acute and sub-acute therapy and now goes 2x a week for out-patient therapy. He has made enormous gains in his range of motion, but is still missing control of his legs and is able to use a walker only by relying on his upper body strength and locking his knees. When he tires, or is in pain, he relies on his wheelchair.

    Since we don't know whether or not his quads will ever function again, I was hoping there was some new treatment to encourage further nerve regeneration. There was something on the internet about transcranial magnetic stimulation (TMS) and pulsed electro-magnetic field (PEMF), but the research was older and there was no follow-up.

    I would really appreciate any suggestions you might offer. Thank you for your time.

  2. #2
    Quote Originally Posted by Jim View Post
    I received this via email, posting it here so Dr. Young can answer-


    Just over a year ago, my husband had a huge herniated disk, which compressed his spinal cord. After surgery, he had both acute and sub-acute therapy and now goes 2x a week for out-patient therapy. He has made enormous gains in his range of motion, but is still missing control of his legs and is able to use a walker only by relying on his upper body strength and locking his knees. When he tires, or is in pain, he relies on his wheelchair.

    Since we don't know whether or not his quads will ever function again, I was hoping there was some new treatment to encourage further nerve regeneration. There was something on the internet about transcranial magnetic stimulation (TMS) and pulsed electro-magnetic field (PEMF), but the research was older and there was no follow-up.

    I would really appreciate any suggestions you might offer. Thank you for your time.
    Much depends on where the disc was herniated and how long it was there before it was decompressed. Although you did not say which segmental levels had the herniated disc, quadricep weakness can result from herniated in the thoracic cord above T11, at T11 or at L2/L3. The spinal cord segment that controls the quadriceps (L2 cord) is situated in the spinal canal at bony vertebral level T11. The spinal cord actually ends just below bony level L1. Below the L1 vertebral body, there is nothing only spinal roots, called the cauda equina (Latin for horse's tail). The L2 and L3 spinal roots exit the spinal column above the L2 and L3 vertebra. A herniated disc at affects these roots can also cause quadricep weakness.

    If the injury is above T11, your husband has a thoracic spinal cord injury that damaged the spinal tracts going to the lumbosacral spinal cord. If so, his legs should paralyzed (i.e. he cannot voluntarily control them) but still spastic (stiff) and can move spontaneously (spasm). His muscles should not undergo too much atrophy.

    If the injury is at T11, your husband may have what is called lumbosacral spinal cord injury. If the injury is at T12 or L1, injury of lower lumbosacral cord and the tip of the spinal cord may occur. The latter is called a conus injury, which typically damage the sacral segments and cause a distinctive loss of motor and sensory function of the pelvic organs. These of course include the bladder, sexual organs, and rectum/anus. The sensory loss follow a "saddle" distribution, i.e. the skin that contacts a saddle would lose sensation.

    There have been relatively few studies of therapies for lumbosacral spinal cord injuries because there is currently no validated animal model for this condition. We are developing a lumbosacral spinal cord injury model (where we contuse the spinal cord between T11 and T12) and will be treating this model with neural stem cells derived from several sources. Because the lumbosacral spinal cord contains the neurons that are responsible for controlling the muscles and neural centers that control walking (called the central pattern generator), regeneration alone may not be sufficient to restore motor function. I am encouraging my colleagues to start studying lumbosacral injuries as well.

    At the present, the only therapies that I know that may be effective for lumbosacral spinal cord injury is to reroute spinal roots to restore bladder and anal function. Dr. Xiao has pioneered procedure that involves bridging a lumbar root to the S2 sacral root that innervates the bladder. Other researchers in China have done rerouting from T11 to S2 for people with conus injuries, reporting return of bladder function for many of these people. Dr. Shao-chen Zhang has been re-connecting peripheral nerves from above the injury (i.e. the ulnar nerve) to leg nerves to restore function to leg muscles.

    Nerve re-routing procedures, however, have serious limitations. In the case of lumbar to sacral nerve re-routing below the injury level, the success rate for people with spinal cord injury has been low in outside of China but apparently has been useful for spina bifida. The reason why is not clear. The Xiao procedure or lumbar-to-sacral rerouting has been used most successfully in children with spina bifida. One possible reason is that many people with higher spinal cord injuries also have injury to the lumbar cord (which T11 injuries would do). For example, if the L5 cord has been damaged, rerouting of the L5 ventral root to the S2 ventral root will not restore bladder function.

    At the present, I don't think that the functional return associated with an ulnar nerve to sciatic nerve bridging is currently sufficient to warrant the bridging surgery. Basically, this procedure sacrifices the ulnar nerve (which receives sensations and controls the fingers of the lateral hand, i.e. the pinky and ring finger) and reroutes it to the main muscle of the nerve. The nerve will regrow and innervate the muscles of the legs. People with this procedure are then able to walk by relearning how to use their nerve signals from their arms to control their legs. The walking is not normal. To avoid numbness and paralysis of the lateral hand, Dr. Zhang usually will split part of the median nerve (which innervates the middle part of the hand) to innervate the lateral hand.

    Regarding PEMF and TMS, I am skeptical that these will have any beneficial effects on spinal cord injury at any level. While we have no truly effective therapies for these injuries, I believe that there will be therapies in the coming years. We are committing to this research area.

    Wise.

  3. #3
    Dr Young, you talked about the goodness of nerve rerouting for lumbosacral injury. How about thoracolumbar injury (L1 burst fracture)? Is nerve rerouting also a comparatively better choice of treatment for this?

    Adapted from my MRI report
    'splaying of the cord/cauda equine nerve roots. An apparent cystic lesion is seen between the splayed dorsal and ventral portion of the cord/cauda equine nerve root ....thereafter cord/cauda nerve roots are tethered posteriorly until the level L2-L3 when they return to the central thecal space.'
    Last edited by Dirly Idol; 04-28-2012 at 04:03 AM.

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