Cortical intermittent theta burst stimulation and neurogenic bladder management after traumatic incomplete spinal cord injury: A case report

Abstract

Context: Neurogenic bladder is one of the major complications of spinal cord injury (SCI). Due to inadequate, ill-timed intervention, it can be lethal and lead to chronic case of renal calculus, renal failure or recurrent urinary tract infections. Intermittent theta burst stimulation (iTBS) is a patterned, non-invasive transcranial magnetic stimulation procedure that can improve the functional status of patients with SCI by manipulating cortico-spinal plasticity. Trans spinal magnetic stimulation has shown transient improvement in establishing voluntary urination and specific bladder parameters in patients with incomplete SCI (iSCI). The present case report evaluates the effect of motor cortical iTBS combined with a customized exercise regime on neurogenic lower urinary tract symptoms in a patient with incomplete dorsal spinal cord injury.

Findings: This is a case of a patient with iSCI who sustaining a stabbing injury. Initial neurological assessment indicated a D5/6 hemi transection. Surgical intervention was followed by cortical iTBS administration for 2 weeks, adjunct to comprehensive rehabilitation for 6 weeks. Urodynamics studies were evaluated for bladder function and neurogenic bladder symptom score (NBSS). We found an improvement in bladder parameters (capacity, compliance, postvoid residual volume, detrusor pressure and bladder indices) linear to the NBSS score, indicating a reduction in neurogenic symptoms.

Conclusion/clinical relevance: iTBS combined with bladder rehabilitation, can be a promising, effective treatment strategy in improving bladder dyssynergia and lower urinary tract dysfunction in patients with incomplete SCI.Trial registration: Clinical Trials Registry India identifier: CTRI/2023/08/056.

Keywords: Bladder rehabilitation; Intermittent theta burst stimulation; Neurogenic bladder; Spinal cord injury; Urodynamics.