Motor disability in patients with multiple sclerosis: transcranial magnetic stimulation study

Anssam Bassem Mohy,Hussein Ghani Kadoori,Aqeel Kareem Hatem,Farqad Bader Hamdan

doi:10.1186/s41983-020-00255-3

Abstract

BackgroundTranscranial magnetic stimulation (TMS) is a non-invasive procedure used in a small targeted region of the brain via electromagnetic induction and used diagnostically to measure the connection between the central nervous system (CNS) and skeletal muscle to evaluate the damage that occurs in MS.ObjectivesThe study aims to investigate whether single-pulse TMS measures differ between patients with MS and healthy controls and to consider if these measures are associated with clinical disability.Patients and methodsSingle-pulse TMS was performed in 26 patients with MS who hand an Expanded Disability Status Scale (EDSS) score between 0 and 9.5 and in 26 normal subjects. Different TMS parameters from upper and lower limbs were investigated.ResultsTMS disclosed no difference in all MEP parameters between the right and left side of the upper and lower limbs in patients with MS and controls. In all patients, TMS parameters were different from the control group. Upper limb central motor conduction time (CMCT) was prolonged in MS patients with pyramidal signs. Upper and lower limb CMCT and CMCT-f wave (CMCT-f) were prolonged in patients with ataxia. Moreover, CMCT and CMCT-f were prolonged in MS patients with EDSS of 5–9.5 as compared to those with a score of 0–4.5. EDSS correlated with upper and lower limb cortical latency (CL), CMCT, and CMCT-f whereas motor evoked potential (MEP) amplitude not.ConclusionTMS yields objective data to evaluate clinical disability and its parameters correlated well with EDSS.

Highlights

Multiple sclerosis (MS) is an autoimmune, progressive chronic central nervous system (CNS) disease of unknown etiology
Transcranial magnetic stimulation (TMS) disclosed no difference in all motor evoked potentials (MEPs) parameters between the right and left side of the upper and lower limbs in patients with MS and controls
No significant difference was demonstrated between the right and left side of the upper and lower limbs considering all MEP parameters (Table 2)

Summary

Introduction

Multiple sclerosis (MS) is an autoimmune, progressive chronic central nervous system (CNS) disease of unknown etiology. The clinical disability of MS has a progressive course with eventual individual and societal impacts [3]. The diagnosis of MS is primarily clinical and relies on the demonstration of symptoms and signs attributable to white matter lesions on magnetic resonance imaging (MRI). The signs and symptoms are disseminated in time (i.e., the disease course) and space (i.e., the affected areas in the CNS), along with the exclusion of other conditions that may resemble MS [7]. Transcranial magnetic stimulation (TMS) is a non-invasive procedure used in a small targeted region of the brain via electromagnetic induction and used diagnostically to measure the connection between the central nervous system (CNS) and skeletal muscle to evaluate the damage that occurs in MS

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Discussion

Conclusion