Open AccessBeneficial effects of combined rTMS and physical rehabilitation for spasticity in multiple sclerosis
Author(s) -
Frederico Arriaga Criscuoli de Farias,
Carolina Matté Dagostini,
Carolina Dalla Santa Dal Moro,
Carolina Odorizzi Magno Nunes,
Mariana Moreira Rizzolli,
Marcelo R. Roxo
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.450
Subject(s) - spasticity , medicine , physical medicine and rehabilitation , transcranial magnetic stimulation , multiple sclerosis , modified ashworth scale , physical therapy , rehabilitation , proprioception , stimulation , psychiatry
Background: spasticity affects up to 90% of multiple sclerosis (MS) patients, being a major cause of disability. Repetitive transcranial magnetic stimulation (rTMS) appears to be a potential treatment, but literature is scarce. Objectives: to evaluate the effects of combined rTMS and physical therapy for spasticity in MS patients. Methods: relapsing-remitting MS patients suffering from lower limb spasticity were included. The rTMS protocol consisted of 20 sessions of 18 trains of 50 stimuli at 5Hz and at 100% of rest potential threshold, with 10 seconds per train and 40 second pauses, amounting for 900 pulses (15 minutes) with a Neurosoft- MS/D double coil. Optimal coil positioning was determined by motor responses in the contralateral soleus muscle. The physical therapy protocol included active exercising – stationary bicycle, step climbing with partial weight suspension – followed by mild gradual resistance exercising for knee extension and hip and foot flexion, proprioceptive exercises and active stretching. The primary outcome was improvement on the Modified Ashworth Scale (MAS) score at baseline and 4 weeks after treatment. Results: five female patients were recruited. At the 4-week follow-up, 4 out the 5 patients had a significant improvement regarding spasticity. There was a reduction in mean MAS score from 2.30 to 1.42. Patient 1 had a MAS score reduction from 2 to 1 (50%). Patient 2 from 3 to 1 (66%), patient 3 from 4 to 3 (25%) and patient 4 from 0.5 to 0.125 (75%). Conclusion: combined rTMS and physical therapy protocols presents as a beneficial treatment modality for MS spasticity.