Assessment of pain and neurological function based on transcranial magnetic stimulation in patients with acute spinal cord injury: a cross-sectional study.
10 affiliations
- 1Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, 200065, China.
- 2Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, 200072, China.
- 3Institute of Spinal and Spinal Cord Injury, Tongji University School of Medicine, Shanghai, 200065, China.
- 4Shanghai Research Center for Spine and Spinal Cord Diseases, Tongji University School of Medicine, Shanghai, 200065, China.
- 5Clinical Center for Brain and Spinal Cord Research, Tongji University School of Medicine, Shanghai, 200065, China.
- 6Division of Spine, Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai, 200065, China. [email protected].
- 7Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, 200072, China. [email protected].
- 8Institute of Spinal and Spinal Cord Injury, Tongji University School of Medicine, Shanghai, 200065, China. [email protected].
- 9Shanghai Research Center for Spine and Spinal Cord Diseases, Tongji University School of Medicine, Shanghai, 200065, China. [email protected].
- 10Clinical Center for Brain and Spinal Cord Research, Tongji University School of Medicine, Shanghai, 200065, China. [email protected].
Abstract
Background
To examine the associations between transcranial magnetic stimulation (TMS) parameters, particularly cortical silent period (CSP) and central motor conduction time (CMCT), and pain severity and neurological impairment in acute spinal cord injury (SCI).Methods
This cross-sectional study included 74 patients with acute SCI who underwent clinical assessment and TMS within 2 weeks after injury. Pain intensity was assessed using the Visual Analog Scale (VAS), and neurological function was evaluated using American Spinal Injury Association (ASIA) motor and sensory scores. TMS was performed over the primary motor cortex, with surface electromyography recorded from the first dorsal interosseous muscles to obtain motor evoked potential (MEP) latency, CMCT, and CSP duration. Spearman correlation, multiple regression, and exploratory ROC curve analyses were applied.Results
CSP duration correlated negatively with VAS score (r = -0.453, P < 0.001) and remained independently associated with pain intensity (P = 0.001). The severe pain group had significantly shorter CSP (68.26 ± 16.28 ms) than the mild/moderate groups. In exploratory ROC analysis, a CSP cutoff of 61.57 ms showed moderate discrimination for severe pain (AUC = 0.759, 95% CI 0.632-0.872; sensitivity 50.0%, specificity 92.6%). For neurological function, both CMCT (r = -0.371, P = 0.001) and MEP latency (r = -0.321, P = 0.005) correlated negatively with ASIA motor scores. Patients with ASIA grade C showed significantly prolonged CMCT compared with grade D (P = 0.007). A CMCT cutoff of 15.40 ms showed moderate discrimination for more severe motor impairment (AUC = 0.769, 95% CI 0.593-0.918; sensitivity 60.0%, specificity 84.4%).Conclusion
Shortened CSP was associated with greater pain severity, while prolonged CMCT was associated with worse motor impairment in acute SCI. Combined assessment of CSP and CMCT may provide complementary electrophysiological information for evaluating pain and motor pathway involvement, but these exploratory findings require validation in independent and longitudinal cohorts.
Related
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BibTeX
@article{gu2026assessment,
title = {{Assessment of pain and neurological function based on transcranial magnetic stimulation in patients with acute spinal cord injury: a cross-sectional study.}},
author = {Chunya Gu and Siqiao Wang and Lijuan Zhao and Rongyu Zhou and Xiaolong Pei and Zhourui Wu and Xiao Hu and Liming Cheng},
journal = {BMC neurology},
year = {2026},
month = jul,
doi = {10.1186/s12883-026-05189-6},
url = {https://europepmc.org/article/MED/42968071},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Assessment of pain and neurological function based on transcranial magnetic stimulation in patients with acute spinal cord injury: a cross-sectional study.
AU - Chunya Gu
AU - Siqiao Wang
AU - Lijuan Zhao
AU - Rongyu Zhou
AU - Xiaolong Pei
AU - Zhourui Wu
AU - Xiao Hu
AU - Liming Cheng
PY - 2026
DA - 2026/07/28
JO - BMC neurology
DO - 10.1186/s12883-026-05189-6
UR - https://europepmc.org/article/MED/42968071
AB - Background To examine the associations between transcranial magnetic stimulation (TMS) parameters, particularly cortical silent period (CSP) and central motor conduction time (CMCT), and pain severity and neurological impairment in acute spinal cord injury (SCI).Methods This cross-sectional study included 74 patients with acute SCI who underwent clinical assessment and TMS within 2 weeks after injury. Pain intensity was assessed using the Visual Analog Scale (VAS), and neurological function was evaluated using American Spinal Injury Association (ASIA) motor and sensory scores. TMS was performed over the primary motor cortex, with surface electromyography recorded from the first dorsal interosseous muscles to obtain motor evoked potential (MEP) latency, CMCT, and CSP duration. Spearman correlation, multiple regression, and exploratory ROC curve analyses were applied.Results CSP duration correlated negatively with VAS score (r = -0.453, P < 0.001) and remained independently associated with pain intensity (P = 0.001). The severe pain group had significantly shorter CSP (68.26 ± 16.28 ms) than the mild/moderate groups. In exploratory ROC analysis, a CSP cutoff of 61.57 ms showed moderate discrimination for severe pain (AUC = 0.759, 95% CI 0.632-0.872; sensitivity 50.0%, specificity 92.6%). For neurological function, both CMCT (r = -0.371, P = 0.001) and MEP latency (r = -0.321, P = 0.005) correlated negatively with ASIA motor scores. Patients with ASIA grade C showed significantly prolonged CMCT compared with grade D (P = 0.007). A CMCT cutoff of 15.40 ms showed moderate discrimination for more severe motor impairment (AUC = 0.769, 95% CI 0.593-0.918; sensitivity 60.0%, specificity 84.4%).Conclusion Shortened CSP was associated with greater pain severity, while prolonged CMCT was associated with worse motor impairment in acute SCI. Combined assessment of CSP and CMCT may provide complementary electrophysiological information for evaluating pain and motor pathway involvement, but these exploratory findings require validation in independent and longitudinal cohorts.
SN - 1471-2377
ER -