Combined intermittent theta-burst stimulation and functional electrical stimulation as adjuncts to intrathecal baclofen in hereditary spastic paraplegia type 11: a case report

Background Spastic paraplegia type 11 (SPG11) is the most common autosomal recessive subtype of hereditary spastic paraplegia, and is characterized by progressive corticospinal tract degeneration, lower-limb spasticity, and gait impairment. Intrathecal baclofen (ITB) effectively alleviates spasticity, but fails to reverse upstream neural pathway damage, resulting in a “functional ceiling” in motor recovery. Intermittent theta-burst stimulation (iTBS) and functional electrical stimulation (FES) have shown potential for enhancing neuroplasticity; however, their combined use as adjuncts to ITB in SPG11 remains unreported. Case presentation A 23-year-old female patient with genetically confirmed SPG11 was admitted 2 weeks after ITB pump implantation with severe lower-limb spasticity, an inability to walk independently, and mild anxiety and depression. The patient underwent a 3-month combined intervention comprising iTBS, FES, and conventional rehabilitation, with dynamic interdisciplinary titration of the ITB dosage. Outcomes were assessed using the Modified Ashworth Scale (MAS), Manual Muscle Testing (MMT), the Berg Balance Scale, center of pressure analysis, the Hamilton Anxiety Scale (HAMA), and the Hamilton Depression Scale (HAMD). Outcomes After 3 months of intervention, the optimal ITB dose was determined to be 62.82 μg/d. The MAS scores of both legs progressively declined, accompanied by increased MMT grades and improved standing balance. The HAMA and HAMD scores were markedly reduced. No adverse events occurred during the treatment. Conclusions The combination of iTBS and FES as adjuncts to ITB was associated with improvements in motor function, balance, and psychological status in patients with SPG11. Dynamic interdisciplinary titration of the ITB dose may be important for balancing spasticity control and motor learning.