title: Effect of repetitive transcranial magnetic stimulation on reducing spasticity in patients suffering from HTLV-1-associated myelopathy.
abstract: OBJECTIVE
  Human T-lymphotropic virus type 1 has been implicated in human T-lymphotropic virus type 1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Regarding its endemicity in Iran and the role of repetitive transcranial magnetic stimulation in reducing spasticity, we decided to evaluate the efficacy of repetitive transcranial magnetic stimulation in reducing spasticity (as primary outcome) and pain, muscle power, and quality of life (as secondary outcomes) in patients suffering from HAM/TSP.
  
  
  METHODS
  In this pretest-posttest study, nine definite patients with HAM/TSP (according to WHO guidelines) were recruited. All patients underwent five consecutive daily sessions of active repetitive transcranial magnetic stimulation (each session consisting of 20 trains of 10 pulses at 5 Hz and an intensity of 90% of resting motor threshold for the biceps brachii muscle). Main outcome measures including spasticity (by modified Ashworth scale), pain (by visual analog scale), muscle power, and quality of life (by SF 36) were measured before the study and days 5, 7, 30 after the termination of the sessions.
  
  
  RESULTS
  Seven (77.8%) females and 2 (22.2%) males were recruited with the mean age of 52 ± 12.67 years, and the mean duration of the disease was 5 ± 3.94. Comparison of the repeated measures showed a statistically significant decrease in pain and spasticity in lower limbs. The decrement in spasticity was persistent even 30 days after the intervention; however, the pain reduction was seen only 5 days after the procedure. No change in quality of life, and muscle power was detected.
  
  
  CONCLUSIONS
  It seems that repetitive transcranial magnetic stimulation could decrease spasticity and pain in patients with HAM/TSP, and this effect could persistently continue by 1 month, but it did not influence patients' muscle power and quality of life, and it could be used as an adjuvant therapy in patients suffering from human T-lymphotropic virus type 1-associated HAM/TSP.
authors.affiliation: Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Amiri
authors.forename: Shahriar
authors.initials: S
authors.lastname: Nafissi
authors.forename: Shirin
authors.initials: S
authors.lastname: Jamal-Omidi
authors.forename: Motahareh
authors.initials: M
authors.lastname: Amiri
authors.forename: Farzad
authors.initials: F
authors.lastname: Fatehi
mesh_terms: D000328:Adult; D005260:Female; D015368:Human T-lymphotropic virus 1 / Q000472:pathogenicity*; D006801:Humans; D007492:Iran; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000294:innervation*; D010146:Pain / Q000503:physiopathology / Q000821:virology; D010147:Pain Measurement; D015493:Paraparesis, Tropical Spastic / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy* / Q000821:virology; D011788:Quality of Life; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome