Motor cortex rTMS improves dexterity in relapsing-remitting and secondary progressive multiple sclerosis

• DOI: 10.1007/s13760-015-0540-y
• Publication Date: 2015-09-10T15:36:49Z
• Authors: Eman Elzamarany; Lamia Afifi; Neveen M. El-Fayoumy; Husam Salah; Mona Nada
• Keywords: Adult; Male; Adolescent; Motor Cortex; Multiple Sclerosis, Chronic Progressive; Transcranial Magnetic Stimulation; Young Adult; 03 medical and health sciences; Multiple Sclerosis, Relapsing-Remitting; 0302 clinical medicine; Humans; Female; 10. No inequality; Psychomotor Performance

The motor cortex (MC) receives an excitatory input from the cerebellum which is reduced in patients with cerebellar lesions. High-frequency repetitive transcranial magnetic stimulation (rTMS) induces cortical facilitation which can counteract the reduced cerebellar drive to the MC. Our study included 24 relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients with dysmetria. The patients were divided into two groups: Group A received two sessions of real MC rTMS and Group B received one session of real rTMS and one session of sham rTMS. Ten healthy volunteers formed group C. Evaluation was carried out using the nine-hole pegboard task and the cerebellar functional system score (FSS) of the expanded disability status scale (EDSS). Group A patients showed a significant improvement in the time required to finish the pegboard task (P = 0.002) and in their cerebellar FSS (P = 0.000) directly after the second session and 1 month later. The RRMS patients showed more improvement than the SPMS patients. Group B patients did not show any improvement in the pegboard task or the cerebellar FSS. These results indicate that MC rTMS can be a promising option in treating both RRMS or SPMS patients with cerebellar impairment and that its effect can be long-lasting.