J Clin Neurol.  2019 Oct;15(4):461-467. 10.3988/jcn.2019.15.4.461.

The Effect of Repetitive Transcranial Magnetic Stimulation on Spasticity in Patients with Multiple Sclerosis

Affiliations
  • 1Department of Physical Rehabilitation Medicine, Karabuk University Karabuk Training and Research Hospital, Karabuk, Turkey. dr.uran@hotmail.com
  • 2Department of Physical Rehabilitation Medicine, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey.

Abstract

BACKGROUND AND PURPOSE
This randomized controlled study examined the effect of repetitive transcranial magnetic stimulation (rTMS) on spasticity in patients with multiple sclerosis (MS).
METHODS
This study included 16 patients with a history of MS and spasticity in the adductor hip muscles according to the Modified Ashworth Scale (MAS). The participants were randomized into the active group (n=10) and control group (n=6), in which active rTMS and sham rTMS were applied in 10 sessions, respectively. A physical therapy and rehabilitation program was applied along with rTMS sessions in both groups. The evaluation parameters were assessed at baseline and then 1 week and 1 month after applying rTMS.
RESULTS
Statistical analyses with post-hoc correction revealed statistically significant improvements in the active group compared to the control group in the bilateral MAS score, Penn Spasm Frequency Scale score, patient satisfaction, amount of urine leakage, actual health status, perceived health status, energy and fatigue, role limitations due to physical problems, social function, overall quality of life, cognitive functioning, physical health composite score, mental health composite score, and total score on the Multiple Sclerosis Quality of Life-54 (MSQOL-54) (p<0.05). Statistically significant changes were detected in the MSQOL-54 social function and physical health composite scores of patients in the control group (p<0.05).
CONCLUSIONS
Active rTMS combined with a physical therapy program reduced spasticity in MS patients compared to the control group that received only physical therapy. Further comprehensive and more advanced studies are needed to confirm the present findings.

Keyword

repetitive transcranial magnetic stimulation; multiple sclerosis; spasticity

MeSH Terms

Fatigue
Hip
Humans
Mental Health
Multiple Sclerosis*
Muscle Spasticity*
Muscles
Patient Satisfaction
Quality of Life
Rehabilitation
Social Problems
Spasm
Transcranial Magnetic Stimulation*

Figure

  • Fig. 1 Flow chart of the study. MS: multiple sclerosis, rTMS: repetitive transcranial magnetic stimulation.

  • Fig. 2 Changes in MAS score for the right hip adductor muscles in the active group over time. MAS: Modified Ashworth Scale.

  • Fig. 3 The changes in MAS scores of the left hip adductor muscles in active group over time. MAS: Modified Ashworth Scale.

  • Fig. 4 Comparison of the active and control groups according to the changes in MAS scores of the right hip adductor muscles before and after the application. MAS: Modified Ashworth Scale.

  • Fig. 5 The comparision of the active and control groups according to the changes in MAS scores of left hip adductor muscles before and after the application. MAS: Modified Ashworth Scale.


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