Acta Neurologica Belgica

, Volume 116, Issue 2, pp 145–150 | Cite as

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

  • Eman Elzamarany
  • Lamia AfifiEmail author
  • Neveen M. El-Fayoumy
  • Husam Salah
  • Mona Nada
Original Article


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.


Repetitive transcranial magnetic stimulation Dysmetria Multiple sclerosis Motor cortex Cerebellum rTMS 



Expanded disability status scale


Functional system score


Long-term potentiation


Long-term depression


Motor cortex


Motor-evoked potential


Multiple sclerosis




Relapsing-remitting multiple sclerosis


Resting motor threshold


Repetitive transcranial magnetic stimulation


Secondary progressive multiple sclerosis


Transcranial magnetic stimulation


Compliance with ethical standards

Conflict of interest

All authors do not have any conflict of interest. The authors received no financial support for the research or authorship of this article.

Ethical approval

The experimental procedures used were approved by the local institutional ethics committee.

Informed consent

Written informed consent was obtained from all subjects.


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Copyright information

© Belgian Neurological Society 2015

Authors and Affiliations

  • Eman Elzamarany
    • 1
  • Lamia Afifi
    • 1
    Email author
  • Neveen M. El-Fayoumy
    • 1
  • Husam Salah
    • 2
  • Mona Nada
    • 1
  1. 1.Clinical Neurophysiology UnitCairo University HospitalsCairoEgypt
  2. 2.Neurology DepartmentCairo University HospitalsCairoEgypt

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