Residual Descending Motor Pathways Influence Spasticity after Spinal Cord Injury

OBJECTIVE: Spasticity is one of the most common symptoms manifested in humans with spinal cord injury (SCI). The neural mechanisms contributing to its development are not yet understood. Using neurophysiological and imaging techniques, we examined the influence of residual descending motor pathways on spasticity in humans with SCI.

METHODS: We measured spasticity in 33 individuals with motor complete SCI (determined by clinical exam) without preservation of voluntary motor output in the quadriceps femoris muscle. To examine residual descending motor pathways, we used magnetic and electrical stimulation over the leg motor cortex to elicit motor evoked potentials (MEPs) in the quadriceps femoris muscle and structural magnetic resonance imaging to measure spinal cord atrophy.

RESULTS: We found that 60% of participants showed symptoms of spasticity while the other 40% showed no spasticity, demonstrating the presence of two clear subgroups of humans with motor complete SCI. MEPs were only present in individuals who had spasticity and MEP size correlated with the severity of spasticity. Spinal cord atrophy was greater in non-spastic compared with spastic subjects. Notably, the degree of spared tissue in the lateral regions of the spinal cord was positively correlated with the severity of spasticity, indicating preservation of white matter related to motor tracts when spasticity was present.

INTERPRETATION: These results support the hypothesis that preservation of descending motor pathways influence spasticity in humans with motor complete SCI; a knowledge that might help the rehabilitation and assessment of people with SCI. This article is protected by copyright. All rights reserved.