Early repetitive transcranial magnetic stimulation in the spinal cord region for the treatment of spinal cord injury: A case report.

Rationale: Currently, the global incidence of spinal cord injury (SCI) ranges from approximately 10.4 to 83 cases per million individuals, with an estimated 500,000 new cases diagnosed annually. Current clinical treatments for SCI primarily include early surgical intervention, pharmacological therapy, and personalized rehabilitation programs. Transcranial magnetic stimulation (TMS) is a noninvasive, painless, and relatively safe treatment option that avoids the side effects and dependency associated with medications. In recent years, TMS has emerged as a promising approach in SCI rehabilitation. However, TMS is often administered late in the course of treatment and typically requires stimulation of multiple sites, which can be time-consuming, cumbersome, and may limit its effectiveness. Recently, we conducted ultra-early single-site TMS on a patient with SCI. Notably, the patient experienced rapid recovery from both motor and sensory impairments, representing a highly successful application of TMS in SCI treatment.

Patient Concerns: The patient is a 57-year-old male who developed low back pain a week ago without any apparent cause. After sitting for extended periods, the pain intensified, making it difficult to turn over. He experienced numbness and weakness in both lower limbs, as well as sensory numbness in the saddle area.

Diagnoses: The rehabilitation evaluation concluded an incomplete SCI, with significant muscle weakness in both lower limbs accompanied by pain, rendering the patient dependent on others for daily care.

Interventions: TMS was administered as a single-target treatment for the L4/L5 intervertebral disc. The treatment parameters included a frequency of 25 Hz, 20 single stimuli per session, a stimulation duration of 0.8 seconds, an interval of 15 seconds between sessions, 76 repetitions per session, and a total of 1520 stimuli per session. The treatment was administered once daily for 5 consecutive days each week, followed by 2 days of rest, and repeated the following week.

Outcomes: After 1 week of treatment, the pain in both lower limbs was significantly alleviated. After 2 weeks, the patient was able to walk independently without the aid of a walker, exhibiting a cross-domain gait. Four weeks later, the patient could walk independently with a normal gait and was able to perform activities of daily living independently. Both the modified Barthel Index and Spinal Cord Independence Measure scores showed significant improvement.

Lessons: The treatment plan adopted for this patient was swift, timely, and precisely targeted, leading to rapid improvements in mobility, sensory function, and activities of daily living in both lower limbs, thereby enabling a quicker recovery of professional and social activity abilities.