title: Motor cortex rTMS improves dexterity in relapsing-remitting and secondary progressive multiple sclerosis.
abstract: The motor cortex (MC) receives an excitatory input from the cerebellum which is reduced in patients with cerebellar lesions. High-frequency repetitive transcranial magnetic stimulation (rTMS) induces cortical facilitation which can counteract the reduced cerebellar drive to the MC. Our study included 24 relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients with dysmetria. The patients were divided into two groups: Group A received two sessions of real MC rTMS and Group B received one session of real rTMS and one session of sham rTMS. Ten healthy volunteers formed group C. Evaluation was carried out using the nine-hole pegboard task and the cerebellar functional system score (FSS) of the expanded disability status scale (EDSS). Group A patients showed a significant improvement in the time required to finish the pegboard task (P = 0.002) and in their cerebellar FSS (P = 0.000) directly after the second session and 1 month later. The RRMS patients showed more improvement than the SPMS patients. Group B patients did not show any improvement in the pegboard task or the cerebellar FSS. These results indicate that MC rTMS can be a promising option in treating both RRMS or SPMS patients with cerebellar impairment and that its effect can be long-lasting.
authors.affiliation: Clinical Neurophysiology Unit, Cairo University Hospitals, Kasr Alainy St., Cairo, 11562, Egypt.
authors.forename: Eman
authors.initials: E
authors.lastname: Elzamarany
authors.affiliation: Clinical Neurophysiology Unit, Cairo University Hospitals, Kasr Alainy St., Cairo, 11562, Egypt. lafifi2@kasralainy.edu.eg.
authors.forename: Lamia
authors.initials: L
authors.lastname: Afifi
authors.affiliation: Clinical Neurophysiology Unit, Cairo University Hospitals, Kasr Alainy St., Cairo, 11562, Egypt.
authors.forename: Neveen M
authors.initials: NM
authors.lastname: El-Fayoumy
authors.affiliation: Neurology Department, Cairo University Hospitals, Cairo, Egypt.
authors.forename: Husam
authors.initials: H
authors.lastname: Salah
authors.affiliation: Clinical Neurophysiology Unit, Cairo University Hospitals, Kasr Alainy St., Cairo, 11562, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Nada
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology; D020528:Multiple Sclerosis, Chronic Progressive / Q000628:therapy*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000628:therapy*; D011597:Psychomotor Performance / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D055815:Young Adult
keywords: Cerebellum; Dysmetria; Motor cortex; Multiple sclerosis; Repetitive transcranial magnetic stimulation; rTMS