Contributions
Abstract: P1268
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: rTMS has emerged as a safe and noninvasive therapeutic tool in improving balance and gait in patients with relapsing remitting multiple sclerosis (pwRRMS). However, its long-term effectiveness has yet to be established; and it remained unclear if such clinical outcome is associated with improvement in the white matter integrity (WMI) or not.
Objectives: To evaluate the long-term efficacy of high-frequency rTMS in management of truncal ataxia in pwRRMS and its impact on WMI assessed by DTI.
Methods: The study included two phases; a randomized, single-blind, sham-controlled phase (phase I) and a longitudinal open-label prospective phase (12 mo) (phase II).
Patients. Forty-three patients with RRMS and truncal ataxia (G+2 and +3 in cerebellum FS) were randomized in phase I to either real (n=20) or sham (n=19) rTMS. In phase II ; all patients received real 12 sessions over 4 weeks (one cycle) every third month to receive a total of 48 sessions (4 cycles). The WMI was assessed using diffusion tensor imaging (DTI) performed for all patients at the screening visit and after the last session in phase II. Voxel based analysis of the DTI metrics of the Cerebro-Ponto-Cerebellar (CPC) and Cerebello-Thalamo-Cerebral (CTC) tracts was performed using FSL calculating the fractional anisotropy (FA) and the mean diffusivity (MD) for each tract. The last relapse was at least 6 months prior to study commencement. During phase II, patients who had relapses were excluded (n=6). The rTMS protocol included 20 trains 20 seconds apart of 50 stimuli (at 5 Hz of 80% of MT) using figure-of-8-shape coil over cerebellum.
Assessment. The 10-m walk test (10MWT) and Berg Balance Scale (BBS) were initially assessed and immediately after the last rTMS session in each cycle. Intention-to-treat analyses were used in analyzing functional outcomes.
Results: There were mild and transitory adverse events [nausea (n=2), headache (n=3), dizziness (n=2)]. The 10MWT and BBS of real rTMS group improved significantly (p< 0.01) and kept improving over the study period with significant difference after last rTMS session (P< 0.001). Percentage of changes after last rTMS session (12th month) for time of 10MWT and BBS were: 36.13%, and 45.9% respectively. The results of MD and FA values showed a longitudinal increase in FA in CPC and CTC bilaterally (p< 0.05).
Conclusion: High frequency rTMS over the cerebellum has a long-term beneficial effect in improving balance and WMI in ataxic pwRRMS.
Disclosure: Hatem S. Shehata: nothing to disclose
Sherif Hamdy: nothing to disclose
Maged Abdelnaseer: nothing to disclose
Imane A. Yassine: nothing to disclose
Talaat Hassan: nothing to disclose
Mona Sherbiny: nothing to disclose
Alaa Elmazny: nothing to disclose
Nevin M. Shalaby: nothing to disclose
Abstract: P1268
Type: Poster Sessions
Abstract Category: Therapy - Symptomatic treatment
Introduction: rTMS has emerged as a safe and noninvasive therapeutic tool in improving balance and gait in patients with relapsing remitting multiple sclerosis (pwRRMS). However, its long-term effectiveness has yet to be established; and it remained unclear if such clinical outcome is associated with improvement in the white matter integrity (WMI) or not.
Objectives: To evaluate the long-term efficacy of high-frequency rTMS in management of truncal ataxia in pwRRMS and its impact on WMI assessed by DTI.
Methods: The study included two phases; a randomized, single-blind, sham-controlled phase (phase I) and a longitudinal open-label prospective phase (12 mo) (phase II).
Patients. Forty-three patients with RRMS and truncal ataxia (G+2 and +3 in cerebellum FS) were randomized in phase I to either real (n=20) or sham (n=19) rTMS. In phase II ; all patients received real 12 sessions over 4 weeks (one cycle) every third month to receive a total of 48 sessions (4 cycles). The WMI was assessed using diffusion tensor imaging (DTI) performed for all patients at the screening visit and after the last session in phase II. Voxel based analysis of the DTI metrics of the Cerebro-Ponto-Cerebellar (CPC) and Cerebello-Thalamo-Cerebral (CTC) tracts was performed using FSL calculating the fractional anisotropy (FA) and the mean diffusivity (MD) for each tract. The last relapse was at least 6 months prior to study commencement. During phase II, patients who had relapses were excluded (n=6). The rTMS protocol included 20 trains 20 seconds apart of 50 stimuli (at 5 Hz of 80% of MT) using figure-of-8-shape coil over cerebellum.
Assessment. The 10-m walk test (10MWT) and Berg Balance Scale (BBS) were initially assessed and immediately after the last rTMS session in each cycle. Intention-to-treat analyses were used in analyzing functional outcomes.
Results: There were mild and transitory adverse events [nausea (n=2), headache (n=3), dizziness (n=2)]. The 10MWT and BBS of real rTMS group improved significantly (p< 0.01) and kept improving over the study period with significant difference after last rTMS session (P< 0.001). Percentage of changes after last rTMS session (12th month) for time of 10MWT and BBS were: 36.13%, and 45.9% respectively. The results of MD and FA values showed a longitudinal increase in FA in CPC and CTC bilaterally (p< 0.05).
Conclusion: High frequency rTMS over the cerebellum has a long-term beneficial effect in improving balance and WMI in ataxic pwRRMS.
Disclosure: Hatem S. Shehata: nothing to disclose
Sherif Hamdy: nothing to disclose
Maged Abdelnaseer: nothing to disclose
Imane A. Yassine: nothing to disclose
Talaat Hassan: nothing to disclose
Mona Sherbiny: nothing to disclose
Alaa Elmazny: nothing to disclose
Nevin M. Shalaby: nothing to disclose