Anodal transcranial direct current stimulation of motor cortex does not ameliorate spasticity in multiple sclerosis

Iodice, Rosa; Dubbioso, Raffaele; Ruggiero, Lucia; Santoro, Lucio; Manganelli, Fiore

doi:10.3233/rnn-150495

Cited by 32 publications

(72 citation statements)

References 36 publications

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“…21 On the contrary, in a randomized study on 20 patients with spasticity, no significant clinical improvement was found after real or sham tDCS applied to the lower limb motor representation for 5 consecutive days. 22 Improvement in hand dexterity in pwMS and cerebellar symptoms after rTMS targeting M1 has been reported shortly after a single session 23 and up to 1 month after two consecutive sessions. 24 Also, 10 daily sessions of iTBS over the hand M1 were associated with significantly better improvement of manual dexterity compared with sham stimulation.…”

Section: Pyramidal Functionmentioning

confidence: 99%

Beyond rehabilitation in MS: Insights from non-invasive brain stimulation

et al. 2019

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The neurobiological basis for targeting neuronal activity in MS brainTo appreciate the relevance of central stimulationbased interventions in MS treatment, we need to start from two basic principles of the neurobiology. First, synapses are highly plastic structures that easily respond and adapt to environmental stimulations, by fine-tuning their connectivity to their synaptic partners. Moreover, neurons can make synaptic contacts with other neurons that have lost part of their synapses in order to restore appropriate functioning of the circuitry and to avoid neuronal loss, thus playing a neuroprotective role. 2 Second, myelin formation and maintenance in the adult brain is a highly dynamic and complex process that continuously takes place to ensure the proper sheathing of axons and, more importantly, is tightly regulated by neuronal activity. 3 These simple neurobiological concepts of neuronal and myelin plasticity lay the ground for developing treatments for a neurological disorder like MS, where an early and progressive loss of synapses occurs in concomitance with demyelination. Therefore, neurons can be targeted to modulate neuronal circuitry and to promote remyelination, which, in fact, is a therapeutic strategy currently under investigation for MS treatment.The idea that neuronal activity can be modulated to modify the disease course and to mitigate the Abstract: Although the number of disease-modifying treatments for people with multiple sclerosis (pwMS) has meaningfully increased in the past years, targeting repair or compensation for central nervous system damage associated with the disease process remains an important clinical goal. With this aim, neurorehabilitation is a powerful approach targeting central nervous system plasticity. Another driver of brain plasticity is non-invasive brain stimulation (NIBS), receiving recent attention in neurology, particularly for its potential synergy with neurorehabilitation and as add-on treatment for several neurological conditions, from pain to fatigue to sensorimotor and cognitive deficits. In this review, we will resume the evidence exploring the neurobiological basis of NIBS and its applications to MS-related conditions.

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Section: Pyramidal Functionmentioning

confidence: 99%

Beyond rehabilitation in MS: Insights from non-invasive brain stimulation

et al. 2019

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“…Although there are a large number of pharmacological and non-pharmacological methods of spasticity management, the problem is still challenging [3][4][5][6][7]. In this regard, the development of new methods of treatment of spasticity has great practical importance.…”

Section: Introductionmentioning

confidence: 99%

High‐frequency repetitive transcranial magnetic stimulation and intermittent theta‐burst stimulation for spasticity management in secondary progressive multiple sclerosis

Korzhova

Bakulin

Синицын

et al. 2019

Euro J of Neurology

104

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Background and purpose The spasticity phenomenon is a significant factor in the development of disability. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment method for this disorder. Our aim was to compare the effects of two protocols of rTMS – the high‐frequency (HF) rTMS (20 Hz) and the intermittent theta‐burst stimulation (iTBS) – on the level of spasticity and concomitant symptoms in patients with secondary progressive multiple sclerosis with an analysis of the duration of the effects up to 12 weeks after the stimulation course. Methods Thirty‐four patients with secondary progressive multiple sclerosis and lower spastic paraparesis were randomized into three groups: (i) HF‐rTMS (20 Hz); (ii) iTBS; (iii) sham stimulation. Spasticity and spasticity‐associated symptoms were assessed by the Modified Ashworth Scale, the Subjective Evaluating Spasticity Scale (SESS), the numerical analog scale, the Modified Fatigue Impact Scale and the pain level scale. Results The Modified Ashworth Scale was significantly reduced after the stimulation course in the HF‐rTMS and iTBS groups. The SESS was reduced post‐intervention and at the two follow‐ups in the iTBS group, whilst HF‐rTMS produced an SESS reduction only at the 2‐week follow‐up, with no effects in the sham group. Conversely, reduction in pain and fatigue was found in the HF‐rTMS group. Conclusions The results show that HF‐rTMS and iTBS significantly reduce spasticity measured by the Modified Ashworth Scale, in contrast to sham stimulation. Some evidence was found in favor of a longer‐lasting effect of iTBS on the SESS and of a reduction in pain and fatigue after HF‐rTMS.

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“…In particular, reduced spasticity was associated with both changes in local connectivity and in the inter-hemispheric balance (Boutière et al, 2017 ). Conversely, one study reported that anodal tDCS on M1 for 5 consecutive days had no clinical impact on spasticity in MS patients (Iodice et al, 2015 ).…”

Section: Nibs and Symptoms Recovery In Msmentioning

confidence: 99%

Remodeling Functional Connectivity in Multiple Sclerosis: A Challenging Therapeutic Approach

Bassi¹,

Gilio²,

Buttari³

et al. 2017

Front. Neurosci.

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Neurons in the central nervous system are organized in functional units interconnected to form complex networks. Acute and chronic brain damage disrupts brain connectivity producing neurological signs and/or symptoms. In several neurological diseases, particularly in Multiple Sclerosis (MS), structural imaging studies cannot always demonstrate a clear association between lesion site and clinical disability, originating the “clinico-radiological paradox.” The discrepancy between structural damage and disability can be explained by a complex network perspective. Both brain networks architecture and synaptic plasticity may play important roles in modulating brain networks efficiency after brain damage. In particular, long-term potentiation (LTP) may occur in surviving neurons to compensate network disconnection. In MS, inflammatory cytokines dramatically interfere with synaptic transmission and plasticity. Importantly, in addition to acute and chronic structural damage, inflammation could contribute to reduce brain networks efficiency in MS leading to worse clinical recovery after a relapse and worse disease progression. These evidence suggest that removing inflammation should represent the main therapeutic target in MS; moreover, as synaptic plasticity is particularly altered by inflammation, specific strategies aimed at promoting LTP mechanisms could be effective for enhancing clinical recovery. Modulation of plasticity with different non-invasive brain stimulation (NIBS) techniques has been used to promote recovery of MS symptoms. Better knowledge of features inducing brain disconnection in MS is crucial to design specific strategies to promote recovery and use NIBS with an increasingly tailored approach.

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Anodal transcranial direct current stimulation of motor cortex does not ameliorate spasticity in multiple sclerosis

Abstract: Five-daily sessions of anodal tDCS to the primary motor cortex does do not improve lower limb spasticity in MS patients.

Cited by 32 publications

References 36 publications

Beyond rehabilitation in MS: Insights from non-invasive brain stimulation

Beyond rehabilitation in MS: Insights from non-invasive brain stimulation

High‐frequency repetitive transcranial magnetic stimulation and intermittent theta‐burst stimulation for spasticity management in secondary progressive multiple sclerosis

Remodeling Functional Connectivity in Multiple Sclerosis: A Challenging Therapeutic Approach

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