Prospective study comparing how different levels and degrees of completeness of SCI affect recto-anal reflexes and how this influences anorectal function and continence
rTMS 10-01
Royal National Orthopaedic Hospital, ImperialCollegeLondon, UniversityCollegeLondon, Award: £39,723, Date: 13 Aug 2010
Control of the urinary bladder and sphincters relies on the integrity of spinal pathways to coordinate proper function. Following supra-sacral spinal cord injury, coordination fails and aberrant sacral reflexes, bladder hyper reflexia and sphincter dyssynergia emerge. Recently we have shown that modulation of the sphincter “guarding reflex”, measured by the pudendo-anal reflex during bladder filling and emptying, is a sensitive and reliable measure of dyssynergia. Preliminary studies have also shown that the reflex is facilitated by single pulse transcranial magnetic stimulation (TMS) of cerebro-spinal pathways in control subjects with weaker modulation in incomplete spinal cord injury.
We hypothesise that by using focal repetitive transcranial magnetic stimulation (rTMS) of residual corticospinal pathways in incomplete spinal injury we can promote positive plastic changes which will facilitate the “guarding reflex” and help reduce both urinary and faecal incontinence.