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Peer-reviewedCC BY 4.0Frontiers in Neurology

Transcranial magnetic stimulation-based multisite neuromodulation for motor recovery after spinal cord injury: a structured narrative review

  • Yuanbiao Luo1
  • Xinwei Huang2
  • Kun Wang3
  • Shunxiu Lu2
  • Jiawen Song4
  • Xin Yang5
  • Feng Li1,6
  • Ye Luo1,6
6 affiliations
  1. 1Department of Orthopaedics, The First Hospital of Putian City, The School of Clinical Medicine, Fujian Medical University
  2. 2Department of Neurology and Neurological Rehabilitation, Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University
  3. 3Department of Rehabilitation Therapy, Kunshan Rehabilitation Hospital
  4. 4Department of Rehabilitation Medicine, Civil Aviation Shanghai Hospital, Gubei Branch of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
  5. 5Department of Rehabilitation Medicine, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University
  6. 6School of Exercise and Health, Shanghai University of Sport
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Abstract

Motor impairment after spinal cord injury (SCI) is associated with disrupted corticospinal transmission and altered interactions among supraspinal, spinal, and peripheral sensorimotor pathways. Conventional transcranial magnetic stimulation (TMS) generally targets the motor cortex alone, whereas multisite approaches combine TMS with peripheral nerve, spinal cord, or nerve-root stimulation. This structured narrative review searched PubMed, Web of Science Core Collection, and SPORTDiscus from database inception through August 1, 2026. The searches identified 260 records, of which 100 unique database records remained after deduplication; five additional records were identified through citation tracking and targeted author searches. Single case reports, conference abstracts, and trial protocols were excluded from the evidence synthesis. Twenty-six eligible publications reporting completed human studies were included in the core synthesis: 17 investigated cortical–peripheral nerve stimulation, seven investigated cortical–spinal stimulation, and two investigated cortical–nerve-root stimulation. One mixed-modality multisegment Hebbian study was considered separately because of its mixed stimulation design. Studies that specified a proposed site of neural interaction and used physiology-based stimulus timing reported timing-dependent changes in corticospinal or spinal excitability. Repeated interventions were also associated with improvements in selected measures of strength, hand function, or walking. Neurophysiological effects were reported more consistently across studies than sustained clinical improvements. Interpretation was limited by small sample sizes, heterogeneous stimulation parameters, overlapping cohorts, limited use of active single-target controls, and differences in treatment exposure. Some paradigms showed timing- or component-dependent neurophysiological effects, but the available evidence does not establish durable clinical efficacy or the added benefit of a second stimulation site across approaches. Future trials should include active single-target comparators, individualized timing where relevant, matched treatment exposure, prespecified stratification by clinically relevant injury characteristics, and long-term clinically meaningful outcomes.

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Cite

BibTeXRIS
BibTeX
@article{luo2026transcranial,
  title = {{Transcranial magnetic stimulation-based multisite neuromodulation for motor recovery after spinal cord injury: a structured narrative review}},
  author = {Yuanbiao Luo and Xinwei Huang and Kun Wang and Shunxiu Lu and Jiawen Song and Xin Yang and Feng Li and Ye Luo},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.2000924},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.2000924/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Transcranial magnetic stimulation-based multisite neuromodulation for motor recovery after spinal cord injury: a structured narrative review
AU  - Yuanbiao Luo
AU  - Xinwei Huang
AU  - Kun Wang
AU  - Shunxiu Lu
AU  - Jiawen Song
AU  - Xin Yang
AU  - Feng Li
AU  - Ye Luo
PY  - 2026
DA  - 2026/10/27
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.2000924
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.2000924/full
AB  - Motor impairment after spinal cord injury (SCI) is associated with disrupted corticospinal transmission and altered interactions among supraspinal, spinal, and peripheral sensorimotor pathways. Conventional transcranial magnetic stimulation (TMS) generally targets the motor cortex alone, whereas multisite approaches combine TMS with peripheral nerve, spinal cord, or nerve-root stimulation. This structured narrative review searched PubMed, Web of Science Core Collection, and SPORTDiscus from database inception through August 1, 2026. The searches identified 260 records, of which 100 unique database records remained after deduplication; five additional records were identified through citation tracking and targeted author searches. Single case reports, conference abstracts, and trial protocols were excluded from the evidence synthesis. Twenty-six eligible publications reporting completed human studies were included in the core synthesis: 17 investigated cortical–peripheral nerve stimulation, seven investigated cortical–spinal stimulation, and two investigated cortical–nerve-root stimulation. One mixed-modality multisegment Hebbian study was considered separately because of its mixed stimulation design. Studies that specified a proposed site of neural interaction and used physiology-based stimulus timing reported timing-dependent changes in corticospinal or spinal excitability. Repeated interventions were also associated with improvements in selected measures of strength, hand function, or walking. Neurophysiological effects were reported more consistently across studies than sustained clinical improvements. Interpretation was limited by small sample sizes, heterogeneous stimulation parameters, overlapping cohorts, limited use of active single-target controls, and differences in treatment exposure. Some paradigms showed timing- or component-dependent neurophysiological effects, but the available evidence does not establish durable clinical efficacy or the added benefit of a second stimulation site across approaches. Future trials should include active single-target comparators, individualized timing where relevant, matched treatment exposure, prespecified stratification by clinically relevant injury characteristics, and long-term clinically meaningful outcomes.
SN  - 1664-2295
ER  -