title: Transcranial magnetic stimulation primes the effects of exercise therapy in multiple sclerosis.
abstract: Exercise therapy (ET) can be beneficial in disabled multiple sclerosis (MS) patients. Intermittent transcranial magnetic theta burst stimulation (iTBS) induces long-term excitability changes of the cerebral cortex and may ameliorate spasticity in MS. We investigated whether the combination of iTBS and a program of ET can improve motor disability in MS patients. In a double-blind, sham-controlled trial, 30 participants were randomized to three different interventions: iTBS plus ET, sham stimulation plus ET, and iTBS alone. Before and after 2 weeks of treatment, measures of spasticity through the modified Ashworth scale (MAS) and the 88 items Multiple Sclerosis Spasticity Score questionnaire (MSSS-88), fatigue through the Fatigue Severity Scale (FSS), daily living activities (ADL) through the Barthel index and health-related quality of life (HRQoL) through the 54 items Multiple Sclerosis Quality of life inventory (MSQoL-54) were collected. iTBS plus ET reduced MAS, MSSS-88, FSS scores, while in the Barthel index and MSQoL-54, physical composite scores were increased. iTBS alone caused a reduction of the MAS score, while none of the measured scales showed significant changes after sham iTBS plus ET. iTBS associated with ET is a promising tool for motor rehabilitation of MS patients.
authors.affiliation: Dipartimento di Neuroscienze, Clinica Neurologica, Università Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mori
authors.forename: Concetta
authors.initials: C
authors.lastname: Ljoka
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Magni
authors.forename: Claudia
authors.initials: C
authors.lastname: Codecà
authors.forename: Hajime
authors.initials: H
authors.lastname: Kusayanagi
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Monteleone
authors.forename: Andrea
authors.initials: A
authors.lastname: Sancesario
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bernardi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Koch
authors.forename: Calogero
authors.initials: C
authors.lastname: Foti
authors.forename: Diego
authors.initials: D
authors.lastname: Centonze
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D004311:Double-Blind Method; D019054:Evoked Potentials, Motor / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000503:physiopathology / Q000534:rehabilitation* / Q000628:therapy*; D016059:Range of Motion, Articular / Q000502:physiology; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods*