P070 Therapeutic possibilities of repetitive magnetic stimulation at patients with various neurological disorders

Abstract

Introduction Repetitive transcranial magnetic stimulation (rTMS) is a promising method in treatment of patients with various neurological diseases not only transcranially, but also at other levels of the nervous system, including peripheral. Currently, there are different protocols for the treatment of patients with neurological disorders at the lumbar level, for the treatment of headache, central pain syndromes and other neurogenic disorders. Objective Goal of this pilot study was to update and adapt existing protocols of rTMS for neurological patients. Methods Therapeutical magnetic stimulation was performed in order to restore lost function or for pain relief between the two groups of observations: patients with the development of compression syndromes in the lumbar level (12 patients) and chronic headache (7 patients) and in two patients with tremor-rigid form of Parkinson’s disease. To avoid terminological confusion, the abbreviation “rTMS” in this paper is applied on the second group of patients and patients with Parkinson’s disease; for the first group, the term “rTMS” is replaced by the already adopted in the literature “rPMS” – rhythmic peripheral magnetic stimulation. After studying international experience (Le Faucheur JP et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clin Neurophysiol 2014), for the first group of patients, it was decided to carry out a rhythmic low frequency stimulation of the lumbosacral (L3-S1) region, in the projection of the nerve structures, which caused motor deficit, sensory disorders, urinary retention. In the second group was used low (less than 5 Hz) and high (5–15 Hz) frequency rTMS at the nape area and left premotor area, respectively. Patients with Parkinson’s disease carried out high-frequency (8–12 Hz) RTMS to the left and right motor areas of the cerebral cortex (M1). For magnetic stimulation device was used MagPro X100 (“Medtronic”, USA) equipped with a circular coil (mcf-125), in combination with neurosensory analyzer “Viking IV” of “Nicolet” (USA) as a diagnostic system. Stimulation was carried at rates of 5–15 sessions lasting 15–35 min, 1 time per day. Results In the first group of patients after rTMS course most of them (8 of 12) subjectively noted relief of the pain syndrome. In more than 60% of cases the effect was persistent: 1.5 months after stimulation. In the second group of patients it was shown that only low-frequency rTMS of cervical-occipital region was ineffective – for 5 sessions, there was no evidence of any significant changes in patient’s status. The positive effect of reducing the intensity and duration of the headaches was noticed only after joining the high-frequency stimulation of the left premotor area (approximately after 8 sessions), which grew progressively by the end of therapy. During dynamic monitoring of patients with Parkinson’s disease positive changes in the motor functions were manifested by about 6–9 magnetic stimulation procedures (increase in muscle strength in the limbs, improvement of the accuracy of movements and improvement of fine motor skills). Thus, these results suggest a promising therapeutic application of rhythmical MS for patients in all represented groups, but verification and refinement of the effects on a larger sample of observations are required. Supported by grant RFBR # 15–29-08304.