Repetitive transcranial magnetic stimulation of the motor cortex ameliorates spasticity in multiple sclerosis.
OBJECTIVE
To investigate whether repetitive transcranial magnetic stimulation (rTMS) can modify spasticity.


METHODS
We used high-frequency (5 Hz) and low-frequency (1 Hz) rTMS protocols in 19 remitting patients with relapsing-remitting multiple sclerosis and lower limb spasticity.


RESULTS
A single session of 1 Hz rTMS over the leg primary motor cortex increased H/M amplitude ratio of the soleus H reflex, a reliable neurophysiologic measure of stretch reflex. Five hertz rTMS decreased H/M amplitude ratio of the soleus H reflex and increased corticospinal excitability. Single sessions did not induce any effect on spasticity. A significant improvement of lower limb spasticity was observed when rTMS applications were repeated during a 2-week period. Clinical improvement was long-lasting (at least 7 days after the end of treatment) when the patients underwent 5 Hz rTMS treatment during a 2-week protocol. No effect was obtained after a 2-week sham stimulation.


CONCLUSIONS
Repetitive transcranial magnetic stimulation may improve spasticity in multiple sclerosis.
Centonze
D
D
Clinica Neurologica, Dipartimento di Neuroscienze, Università di Tor Vergata, Rome, Italy. centonze@uniroma2.it
Koch
G
G
Versace
V
V
Mori
F
F
Rossi
S
S
Brusa
L
L
Grossi
K
K
Torelli
F
F
Prosperetti
C
C
Cervellino
A
A
Marfia
G A
GA
Stanzione
P
P
Marciani
M G
MG
Boffa
L
L
Bernardi
G
G
D000328:Adult; D005260:Female; D006181:H-Reflex / Q000502:physiology; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009103:Multiple Sclerosis / Q000150:complications* / Q000503:physiopathology; D009119:Muscle Contraction / Q000502:physiology; D009122:Muscle Hypertonia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D009128:Muscle Spasticity / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D011712:Pyramidal Tracts / Q000503:physiopathology; D012021:Reflex, Abnormal / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome