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

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.

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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

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Correspondence to Lamia Afifi.

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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.

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Written informed consent was obtained from all subjects.

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Elzamarany, E., Afifi, L., El-Fayoumy, N.M. et al. Motor cortex rTMS improves dexterity in relapsing-remitting and secondary progressive multiple sclerosis. Acta Neurol Belg 116, 145–150 (2016). https://doi.org/10.1007/s13760-015-0540-y

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Keywords

  • Repetitive transcranial magnetic stimulation
  • Dysmetria
  • Multiple sclerosis
  • Motor cortex
  • Cerebellum
  • rTMS