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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

Abstract

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.

Keywords

Repetitive transcranial magnetic stimulation Dysmetria Multiple sclerosis Motor cortex Cerebellum rTMS 

Abbreviations

EDSS

Expanded disability status scale

FSS

Functional system score

LTP

Long-term potentiation

LTD

Long-term depression

MC

Motor cortex

MEP

Motor-evoked potential

MS

Multiple sclerosis

NMDA

N-methyl-D-aspartate

RRMS

Relapsing-remitting multiple sclerosis

RMT

Resting motor threshold

rTMS

Repetitive transcranial magnetic stimulation

SPMS

Secondary progressive multiple sclerosis

TMS

Transcranial magnetic stimulation

Notes

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.

References

  1. 1.
    Compston A, Coles A (2008) Multiple sclerosis. Lancet 372:1502–1517CrossRefPubMedGoogle Scholar
  2. 2.
    Ruutiainen J (1997) Assessment and treatment of ataxia in multiple sclerosis. In: Ketelaer P, Prosiegel M, Battaglia M, Messmer U (eds) A problem-oriented approach to multiple sclerosis. Amersfoort, Leuven, pp 227–235Google Scholar
  3. 3.
    Weinshenker BG, Issa M, Baskerville J (1996) Long-term and short-term outcome of multiple sclerosis. A 3-year follow-up study. Arch Neurol 53:353–358CrossRefPubMedGoogle Scholar
  4. 4.
    Beaubaton D, Trouche E (1980) Participation of the cerebellar dentate nucleus in the control of a goal-directed movement in monkeys. Exp Brain Res 46:127–138CrossRefGoogle Scholar
  5. 5.
    Daskalakis ZJ, Paradiso GO, Christensen BK, Fitzgerald PB, Gunraj C, Chen R (2004) Exploring the connectivity between the cerebellum and motor cortex in humans. J Physiol 557(Pt 2):689–700CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Liepert J, Kucinski T, Tuscher O, Pawlas F, Baumer T, Weiller C (2004) Motor cortex excitability after cerebellar infarction. Stroke 35:2484–2488CrossRefPubMedGoogle Scholar
  7. 7.
    Kamble N, Netravathi M, Pal PK (2014) Therapeutic applications of repetitive transcranial magnetic stimulation (rTMS) in movement disorders: a review. Parkinsonism Relat Disord 20:695–707CrossRefPubMedGoogle Scholar
  8. 8.
    Centonze D, Koch G, Versace V, Mori F, Rossi S, Brusa L et al (2007) Repetitive transcranial magnetic stimulation of the motor cortex ameliorates spasticity in multiple sclerosis. Neurology 68:1045–1050CrossRefPubMedGoogle Scholar
  9. 9.
    Koch G, Rossi S, Prosperetti C, Codecà C, Monteleone F, Petrosini L et al (2008) Improvement of hand dexterity following motor cortex rTMS in multiple sclerosis patients with cerebellar impairment. Mult Scler 14:995–998CrossRefPubMedGoogle Scholar
  10. 10.
    McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127CrossRefPubMedGoogle Scholar
  11. 11.
    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33:1444–1452CrossRefPubMedGoogle Scholar
  12. 12.
    Shiga Y, Tsuda T, Itoyama Y, Shimizu H, Miyazawa KI, Jin K et al (2002) Transcranial magnetic stimulation alleviates truncal ataxia in spinocerebellar degeneration. J Neurol Neurosurg Psychiatry 72:124–126CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Farzan F, Wu Y, Manor B, Anastasio EM, Lough M, Novak V et al (2013) Cerebellar TMS in treatment of a patient with cerebellar ataxia: evidence from clinical, biomechanics and neurophysiological assessments. Cerebellum 12:707–712CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Bonnì S, Ponzo V, Caltagirone C, Koch G (2014) Cerebellar theta burst stimulation in stroke patients with ataxia. Funct Neurol 29:41–45PubMedPubMedCentralGoogle Scholar
  15. 15.
    Cohen JA, Fischer JS, Bolibrush DM, Jak AJ, Kniker JE, Mertz LA (2000) Intrarater and interrater reliability of the MS functional composite outcome measure. Neurology 54:802–806CrossRefPubMedGoogle Scholar
  16. 16.
    Kragt JJ, van der Linden FAH, Nielsen JM, Uitdehaag BMJ, Polman CH (2006) Clinical impact of 20% worsening on timed 25-foot walk and 9-hole peg test in multiple sclerosis. Mult Scler 12:594–598CrossRefPubMedGoogle Scholar
  17. 17.
    Ghez C, Thach WT (2000) The cerebellum, 4th edn. McGraw-Hill Health Professions Division, New YorkGoogle Scholar
  18. 18.
    Pozzi NG, Minafra B, Zangaglia R, De Marzi R, Sandrini G, Priori A et al (2014) Transcranial direct current stimulation (tDCS) of the cortical motor areas in three cases of cerebellar ataxia. Cerebellum 13:109–112CrossRefPubMedGoogle Scholar
  19. 19.
    Oechsner M, Zangemeister WH (1999) Prolonged postexcitatory inhibition after transcranial magnetic stimulation of the motor cortex in patients with cerebellar ataxia. J Neurol Sci 168:107–111CrossRefPubMedGoogle Scholar
  20. 20.
    Cooke SF, Bliss TV (2006) Plasticity in the human central nervous system. Brain 129:1659–1673CrossRefPubMedGoogle Scholar
  21. 21.
    Malenka R, Bear M (2004) LTP and LTD: an embarrassment of riches. Neuron 44:5–21CrossRefPubMedGoogle Scholar

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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