Contributions
Abstract: P779
Type: Poster
Abstract Category: RIMS - Multi-disciplinary rehabilitation
Gait disturbance is among the most common mobility limitation in chronic multiple sclerosis (MS). It is often of multifactorial origin and is characterized by decreased walking endurance, speed, cadence and step length. Emerging evidence suggests a role of prefrontal attention networks in gait modulation. High-frequency repetitive transcranial magnetic stimulation (rTMS) is known to enhance cortical excitability in the stimulated cortex and its connections.
Objective: Investigated the safety and efficacy of high-frequency (10 Hz) prefrontal rTMS on gait parameters and balance in patients with chronic relapsing/remitting (RR) or secondary progressive (SP) MS with residual gait disability.
Subjects and methods: This was a randomized, placebo controlled single blinded pilot study that included 31 MS patients (13 RR, 18 SP) with Expanded Disability Status Scale (EDSS) (4.5 - 6.0) and with residual disability in gait symptoms (aged 38.4 ± 8.9 years). During the 4-weeks study duration, patients were randomized to receive 20 sessions of either real (n=16) or sham (n=15) rTMS sessions, both groups received the same rehabilitation program that included gait training, enhancing motor learning and balance exercises. In real rTMS sessions, a total 2000 pulses of 10-Hz rTMS were delivered through 20 trains at 90% of motor threshold over the left prefrontal area. All patients were assessed at baseline and after the intervention using Timed Up and Go Test (TUG), 10-Meter Walking Test (TMWT), Berg Balance Scale, Four Square Step Test (FSST) and functional gait assessment (FGA).
Results: Both groups showed significant improvement after completion of the study protocol in all efficacy variables. On comparing between real and sham groups, there were significant decrease in the performance time for TMWT (p< 0.02) and TUG (p < 0.05) with improvement of FGA (p< 0.01) and balance parameters (p< 0.02) for those who received real rTMS. There were no reported adverse events apart from mild and transient headaches.
Conclusions: High-frequency rTMS on the left prefrontal cortex is a possible effective and safe treatment option for patients with MS to improve walking function and balance capabilities in addition to the standardized physical therapy.
Disclosure:
Hatem S. Shehata: nothing to disclose
Nevin M. Shalaby: nothing to disclose
Alaa Elmazny: nothing to disclose
Abstract: P779
Type: Poster
Abstract Category: RIMS - Multi-disciplinary rehabilitation
Gait disturbance is among the most common mobility limitation in chronic multiple sclerosis (MS). It is often of multifactorial origin and is characterized by decreased walking endurance, speed, cadence and step length. Emerging evidence suggests a role of prefrontal attention networks in gait modulation. High-frequency repetitive transcranial magnetic stimulation (rTMS) is known to enhance cortical excitability in the stimulated cortex and its connections.
Objective: Investigated the safety and efficacy of high-frequency (10 Hz) prefrontal rTMS on gait parameters and balance in patients with chronic relapsing/remitting (RR) or secondary progressive (SP) MS with residual gait disability.
Subjects and methods: This was a randomized, placebo controlled single blinded pilot study that included 31 MS patients (13 RR, 18 SP) with Expanded Disability Status Scale (EDSS) (4.5 - 6.0) and with residual disability in gait symptoms (aged 38.4 ± 8.9 years). During the 4-weeks study duration, patients were randomized to receive 20 sessions of either real (n=16) or sham (n=15) rTMS sessions, both groups received the same rehabilitation program that included gait training, enhancing motor learning and balance exercises. In real rTMS sessions, a total 2000 pulses of 10-Hz rTMS were delivered through 20 trains at 90% of motor threshold over the left prefrontal area. All patients were assessed at baseline and after the intervention using Timed Up and Go Test (TUG), 10-Meter Walking Test (TMWT), Berg Balance Scale, Four Square Step Test (FSST) and functional gait assessment (FGA).
Results: Both groups showed significant improvement after completion of the study protocol in all efficacy variables. On comparing between real and sham groups, there were significant decrease in the performance time for TMWT (p< 0.02) and TUG (p < 0.05) with improvement of FGA (p< 0.01) and balance parameters (p< 0.02) for those who received real rTMS. There were no reported adverse events apart from mild and transient headaches.
Conclusions: High-frequency rTMS on the left prefrontal cortex is a possible effective and safe treatment option for patients with MS to improve walking function and balance capabilities in addition to the standardized physical therapy.
Disclosure:
Hatem S. Shehata: nothing to disclose
Nevin M. Shalaby: nothing to disclose
Alaa Elmazny: nothing to disclose