Motor cortex rTMS improves dexterity in relapsing-remitting and secondary progressive multiple sclerosis

Elzamarany, Eman; Afifi, Lamia; El-Fayoumy, Neveen M.; Salah, H. Haj; Nada, Mona

doi:10.1007/s13760-015-0540-y

Cited by 27 publications

(34 citation statements)

References 18 publications

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“…The choice of polarity was based on the results obtained following the application of repetitive transcranial magnetic stimulation (rTMS), which is another NIBS technique. High frequency rTMS applied over the motor cortex improved hand dexterity in MS subjects with cerebellar impairment possibly by increasing the motor cortex excitability [76,77]. In another study involving patients with essential tremor, low frequency rTMS applied over the cerebellum was able to improve the amplitude of tremor, a finding that might have occurred due to the decrease in excitability of the cerebellar cortex [78].…”

Section: Discussionmentioning

confidence: 99%

Effects of Transcranial Direct Current Stimulation on Hand Dexterity in Multiple Sclerosis: A Design for a Randomized Controlled Trial

et al. 2020

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Background: Cerebellar and motor tracts are frequently impaired in multiple sclerosis (MS). Altered hand dexterity constitutes a challenge in clinical practice, since medical treatment shows very limited benefits in this domain. Cerebellar control is made via several cerebellocortical pathways, of which the most studied one links the cerebellum to the contralateral motor cortex via the contralateral ventro-intermediate nucleus of the thalamus influencing the corticospinal outputs. Modulating the activity of the cerebellum or of the motor cortex could be of help. Method: The main interest here is to evaluate the efficacy of transcranial direct current stimulation (tDCS), a noninvasive brain stimulation technique, in treating altered dexterity in MS. Forty-eight patients will be recruited in a randomized, double-blind, sham-controlled, and crossover study. They will randomly undergo one of the three interventions: anodal tDCS over the primary motor area, cathodal tDCS over the cerebellum, or sham. Each block consists of five consecutive daily sessions with direct current (2 mA), lasting 20 min each. The primary outcome will be the improvement in manual dexterity according to the change in the time required to complete the nine-hole pegboard task. Secondary outcomes will include fatigue, pain, spasticity, and mood. Patients’ safety and satisfaction will be rated. Discussion: Due to its cost-effective, safe, and easy-to-use profile, motor or cerebellar tDCS may constitute a potential tool that might improve dexterity in MS patients and therefore ameliorate their quality of life.

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Section: Discussionmentioning

confidence: 99%

Effects of Transcranial Direct Current Stimulation on Hand Dexterity in Multiple Sclerosis: A Design for a Randomized Controlled Trial

et al. 2020

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“…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. 25 Anodal tDCS applied to M1 contralateral to the more severely impaired hand increased the corticospinal output and projection strength evaluated with the input/output curve, but no behavioral effects were measured.…”

Section: Pyramidal Functionmentioning

confidence: 89%

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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“…MS sufferers may also suffer from a cerebellar sign called dysmetria, frequently accompanied by ataxia, tremor and uncoordinated movements in the extremities. Lesions in the cerebellum play an essential part in the manifestation of symptoms, especially for limb coordination and motor performance [48]. Finally, eye movement disorders, such as internuclear ophthalmoplegia resulting from lesions in the medial longitudinal fasciculus in the brainstem [49,50] and nystagmus [49,51], are frequent in MS [34].…”

Section: Motor Symptomsmentioning

confidence: 99%

Temperature sensitivity in multiple sclerosis: An overview of its impact on sensory and cognitive symptoms

et al. 2018

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Multiple sclerosis (MS) is an autoimmune neurodegenerative disease characterized by demyelination of the central nervous system (CNS). The exact cause of MS is still unknown; yet its incidence and prevalence rates are growing worldwide, making MS a significant public health challenge. The heterogeneous distribution of demyelination within and between MS patients translates in a complex and varied array of autonomic, motor, sensory and cognitive symptoms. Yet a unique aspect of MS is the highly prevalent (60-80%) temperature sensitivity of its sufferers, where neurological symptoms are temporarily exacerbated by environmental-or exercise-induced increases (or decreases) in body temperature. MS temperature sensitivity is primarily driven by temperature-dependent slowing or blocking of neural conduction within the CNS due to changes in internal (core) temperature; yet changes in skin temperature could also contribute to symptom exacerbation (e.g. during sunlight and warm ambient exposure). The impact of temperature sensitivity, and particularly of increases in core temperature, on autonomic (e.g. thermoregulatory/cardiovascular function) and motor symptoms (e.g. fatigue) is well described. However, less attention has been given to how increases (and decreases) in core and skin temperature affect sensory and cognitive symptoms. Furthermore, it remains uncertain whether changes in skin temperature alone could also trigger worsening of symptoms. Here we review the impact of temperature sensitivity on MS sensory and cognitive function and discuss additional factors (e.g. changes in skin temperature) that potentially contribute to temperature-induced worsening of symptoms in the absence of alteration in core temperature.

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Motor cortex rTMS improves dexterity in relapsing-remitting and secondary progressive multiple sclerosis

Cited by 27 publications

References 18 publications

Effects of Transcranial Direct Current Stimulation on Hand Dexterity in Multiple Sclerosis: A Design for a Randomized Controlled Trial

Effects of Transcranial Direct Current Stimulation on Hand Dexterity in Multiple Sclerosis: A Design for a Randomized Controlled Trial

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

Temperature sensitivity in multiple sclerosis: An overview of its impact on sensory and cognitive symptoms

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