Nexstim: Improving spinal cord injury outcomes with TMS

Finnish neurotech company Nexstim partners with researchers from a wide range of disciplines who believe in the potential of TMS to build neuroplasticity and improve patient outcomes.

Nexstim navigated TMS (nTMS) has shown significant potential as a novel therapy for spinal cord injury (SCI).

SCI is an area of high unmet clinical need, with up to half a million new cases globally every year.

Dr Anastasia Shulga is a neurologist and principal investigator at the BioMag Laboratory at Helsinki University Hospital in Finland.

Dr Shulga leads an SCI research group focused on the restoration of upper and lower-limb function using a TMS technique called paired associated stimulation (PAS).

The researcher said:

“Our project is mainly focused on the Hebb Principle, which says ‘neurons that fire together, wire together.’

“The idea is to activate upper and lower motor neurons of the spinal cord to promote neural wiring to help patients after spinal cord damage.”

Nexstim nTMS is combined with a peripheral nerve stimulation (PNS) device, with nTMS targeting the brain while PNS targets nerves in the arm, hand and foot.

A computer triggers each stimulation with millisecond precision to elicit a response.

Dr Shulga and her team have conducted a number of studies on quadraplegic patients, with the technique improving average muscle strength and function in every case series.

In a recent study, a patient with severe quadriplegia was treated with PAS for as long as required.

After about a year, muscle strength and function were normal for both hands according to the Manual Muscle Test (MMT) used by physiotherapists.

Dr Shulga

Clinicians also saw a ‘remarkable’ increase in Spinal Cord Independence Measure (SCIM).

SCIM looks at self-care measures such as feeding, grooming and bathing, respiration and sphincter management, and the patient’s movement abilities.

Dr Shulga said:

“The patient became able to eat and drink independently, wash independently and dress independently. He could also groom himself and transfer from a bed to a chair.

“It also became much easier for him to manipulate small objects.”

A paraplegic man was recruited into a study a year after sustaining his SCI. The man was unable to walk independently, relying on a weight support to move around.

After three months of PAS, the man was able to stand and walk a few steps without weight support.

His condition improved, the man was moved into conventional rehabilitation.

Following rehab, the patient was given a further three months of PAS. At the end of the project, he could walk with the aid of a walker 50 per cent of the time.

TMS has been essential to the success of the PAS treatment, as demonstrated in a 2019 study by the team at Helsinki University Hospital .

Treatment with TMS showed an MMT score of 1.4 – more than double that of the non-TMS group.

TMS patients also showed significant improvements in a number of functional tests not seen in the other patients.

While the PAS technique is experimental and not yet FDA-approved, it’s clearly having a real impact in patients’ everyday lives.

Dr Shulga said:

“I believe that the results are clinically meaningful.

“Patients have told us that they’ve been able to do new things after the trial that they hadn’t been able to do before.

“The results will depend on how long you stimulate.

“A patient who had been with us for a very long time experienced some really significant changes.

“But even patients who undergo just four or six weeks of stimulation report changes in their everyday lives as well.

“One that immediately comes to mind is a patient who was able to play guitar again after completing the treatment.”