title: Low and high frequency repetitive transcranial magnetic stimulation for the treatment of spasticity.
abstract: The development of non-invasive techniques of cortical stimulation, such as transcranial magnetic stimulation (TMS), has opened new potential avenues for the treatment of neuropsychiatric diseases. We hypothesized that an increase in the activity in the motor cortex by cortical stimulation would increase its inhibitory influence on spinal excitability through the corticospinal tract and, thus, reduce the hyperactivity of the gamma and alpha neurons, improving spasticity. Seventeen participants (eight males, nine females; mean age 9y 1mo [SD 3y 2mo]) with cerebral palsy and spastic quadriplegia were randomized to receive sham, active 1Hz, or active 5Hz repetitive TMS of the primary motor cortex. Stimulation was applied for 5 consecutive days (90% of motor threshold). The results showed that there was a significant reduction of spasticity after 5Hz, but not sham or 1Hz, stimulation as indexed by the degree of passive movement; however this was not evident when using the Ashworth scale, although a trend for improvement was seen for elbow movement. The safety evaluation showed that stimulation with either 1Hz or 5Hz did not result in any adverse events as compared with sham stimulation. Results of this trial provide initial evidence to support further trials exploring the use of cortical stimulation in the treatment of spasticity.
authors.affiliation: Department of Pathology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Angela C
authors.initials: AC
authors.lastname: Valle
authors.forename: Karen
authors.initials: K
authors.lastname: Dionisio
authors.forename: Naomi Bass
authors.initials: NB
authors.lastname: Pitskel
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
authors.forename: Fernanda
authors.initials: F
authors.lastname: Orsati
authors.forename: Merari J L
authors.initials: MJ
authors.lastname: Ferreira
authors.forename: Paulo S
authors.initials: PS
authors.lastname: Boggio
authors.forename: Moises C
authors.initials: MC
authors.lastname: Lima
authors.forename: Sergio P
authors.initials: SP
authors.lastname: Rigonatti
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000628:therapy*; D002648:Child; D004307:Dose-Response Relationship, Radiation; D004311:Double-Blind Method; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011782:Quadriplegia / Q000628:therapy*; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome