Inclusion Criteria:
1. Age between 18 and 75 years.
2. At least 2 months since spinal cord injury.
3. Cervical spinal cord injury (C1-C8) with AIS A-D.
4. Muscle strength should be within a range of 5 to 40 points on the UEMS score.
5. Capacity to provide informed consent.
Exclusion Criteria:
1. High suicide risk assessed by C-SSRS.
2. History of severe psychiatric disorders, major depression or prior suicide attempts.
3. Treatment with anticoagulants or strong CYP3A4 inhibitors or inducers (inhibitors such as ketoconazole, itraconazole, ritonavir, telithromycin, clarithromycin, or nefazodone, and inducers such as rifampicin, phenytoin, phenobarbital, carbamazepine, or St. John's Wort).
4. Body Mass Index (BMI) \> 40 kg/m².
5. Pregnancy or breastfeeding.
6. Fertile men or women who cannot guarantee the use of highly effective contraceptive methods, as defined by the European HMA-CTFG guidelines-i.e., those with a failure rate of less than 1 % per year when used consistently and correctly (1).
A woman is considered fertile if she is physiologically capable of becoming pregnant, from menarche until postmenopausal, unless permanently sterile. Permanent sterilization methods include hysterectomy, bilateral salpingectomy, and bilateral oophorectomy. A woman is considered postmenopausal after spontaneous amenorrhea for at least 12 consecutive months with no alternative medical cause. An elevated follicle-stimulating hormone (FSH) level in the postmenopausal range may be used to support the diagnosis in women not using hormonal contraception or hormone replacement therapy. However, in the absence of 12 months of amenorrhea, a single FSH measurement is not sufficient.
Acceptable highly effective contraceptive methods include:
* Combined hormonal contraception (containing estrogen and progestogen) associated with ovulation inhibition, administered orally, vaginally, or transdermal.
* Progestogen-only hormonal contraception associated with ovulation inhibition (oral, injectable, or implantable).
* Intrauterine device (IUD).
* Intrauterine hormone-releasing system (IUS).
* Bilateral tubal occlusion.
* Vasectomized partner: provided this is the participant's sole sexual partner and the vasectomy has been medically confirmed as successful.
* Sexual abstinence: refraining from heterosexual intercourse during the entire treatment and follow-up period.
7. Uncontrolled hypothyroidism, or a history of severe bone, liver, or kidney disease.
8. Inability to attend hospital visits.
9. Known allergy to rimonabant or any of the excipients used.
10. Participation in another clinical trial with pharmacological intervention within the month prior to enrolment.
11. Any other condition that, in the opinion of the investigator, makes the subject's participation in the study unrecommended, such as severe heart failure or uncontrolled diabetes.
12. Contraindications for transcranial magnetic stimulation (TMS), such as metal implants in the head, pacemakers, epileptic seizures in the last two years, or other implanted electronic devices.
