Spasticity Management: The Current State of Transcranial Neuromodulation

Leo, Antonino; Naro, Antonino; Molonia, Francesco; Tomasello, Provvidenza; Saccà, Ileana; Bramanti, Alessia; Russo, Margherita; Bramantı, Placido; Quartarone, Angelo; Calabrò, Rocco Salvatore

doi:10.1016/j.pmrj.2017.03.014

Cited by 25 publications

(10 citation statements)

References 107 publications

(206 reference statements)

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“…It has been shown in the literature that five to 10 sessions of high‐frequency (HF)‐rTMS or intermittent theta‐burst stimulation (iTBS) of the primary motor cortex reduce spasticity by 18%–42% in patients with MS . Both protocols can reduce the level of spasticity by increasing the excitability of the primary motor cortex and as a result increasing the downward inhibitory effects of gamma motoneurons .…”

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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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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“…Two reviews ( 129 , 130 ) have concluded that, overall, the studies have small sample sizes and varying quality, with PEDro scores ranging from 6 to 10. Thus, they lack the power needed to draw firm conclusions on the effect of FES as an adjunctive treatment with BoNT-A.…”

Section: Concomitant and Adjunctive Therapiesmentioning

confidence: 99%

A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A: An international group consensus

Francisco¹,

Balbert²,

Bavikatte³

et al. 2021

J Rehabil Med

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A group of doctors from around the world, who are experts in treating muscle stiffness and spasm (also called spasticity), reviewed the current scientific evidence supporting the effectiveness of using botulinum toxin injections in treatment of spasticity that results from a stroke. When evidence is not available, they discussed and agreed on the best way to treat spasticity using botulinum toxin. The recommendations made by these expert doctors can be used by less-experienced doctors as a guide to how best to use botulinum toxin injection in treating spasticity after a stroke. This consensus paper is derived from a meeting of an international group of 19 neurological rehabil itation specialists with a combined experience of more than 250 years (range 4-25 years; mean 14.1 years) in treating poststroke spasticity with bot ulinum toxin A. The group undertook critical assess ments of some recurring practical challenges, not yet addressed in guidelines, through an exten sive literature search. They then discussed the results in the light of their individual clinical experience and developed consensus statements to present to the wider community who treat such patients. The analy sis provides a comprehensive overview of treatment with botulinum toxin A, including the use of adjunctive therapies, within a multidisciplinary con text, and is aimed at practicing clinicians who treat patients with poststroke spasticity and require further practical guidance on the use of botulinum toxin A. This paper does not replicate information published elsewhere, but instead aims to provide practical advice to help optimize the use of botulinum toxin A and maximize clinical outcomes. The recom mendations for each topic are summarized in a se ries of statements. Where published highquality evidence exists, the recommendations reflect this. However, where evidence is not yet conclusive, the group members issued statements and, in some cas es, made recommendations based on their clinical experience.

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“…Around 36% of the patients suffered moderate or severe upper limb spasticity (Nam et al, 2019). Weakness, pain, loss of dexterity, stiffness, fibrosis, and atrophy followed by upper limb PSS always contribute to disordered motor control, functional limitations, and poor quality of life that result in an increased burden on caregivers (Leo et al, 2017;Li et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Cerebellar Intermittent Theta-Burst Stimulation Reduces Upper Limb Spasticity After Subacute Stroke: A Randomized Controlled Trial

Chen

Wei

Zhang

et al. 2021

Front. Neural Circuits

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Objective: This study aims to explore the efficacy of cerebellar intermittent theta-burst stimulation (iTBS) on upper limb spasticity in subacute stroke patients.Methods: A total of 32 patients with upper limb spasticity were enrolled and randomly assigned to treatment with cerebellar iTBS or sham stimulation before conventional physical therapy daily for 2 weeks. The primary outcomes included the modified Ashworth scale (MAS), the modified Tardieu scale (MTS), and the shear wave velocity (SWV). The secondary outcomes were the H-maximum wave/M-maximum wave amplitude ratio (Hmax/Mmax ratio), motor-evoked potential (MEP) latency and amplitude, central motor conduction time (CMCT), and the Barthel Index (BI). All outcomes were evaluated at baseline and after 10 sessions of intervention.Results: After the intervention, both groups showed significant improvements in the MAS, MTS, SWV, and BI. In addition, patients treated with cerebellar iTBS had a significant increase in MEP amplitude, and patients treated with sham stimulation had a significant decrease in Hmax/Mmax ratio. Compared with the sham stimulation group, the MAS, MTS, and SWV decreased more in the cerebellar iTBS group.Conclusion: Cerebellar iTBS is a promising adjuvant tool to reinforce the therapeutic effect of conventional physical therapy in upper limb spasticity management after subacute stroke (Chinese Clinical Trial Registry: ChiCTR1900026516).

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Spasticity Management: The Current State of Transcranial Neuromodulation

Abstract: V.

Cited by 25 publications

References 107 publications

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

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

A practical guide to optimizing the benefits of post-stroke spasticity interventions with botulinum toxin A: An international group consensus

Cerebellar Intermittent Theta-Burst Stimulation Reduces Upper Limb Spasticity After Subacute Stroke: A Randomized Controlled Trial

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