Use of a metaplasticity-based protocol of therapeutic transcranial magnetic stimulation in patients with progressive multiple sclerosis and spasticity: first experience

Abstract

Background. Spasticity is a disabling syndrome frequently observed in progressive multiple sclerosis. One of the promising approaches to the treatment of spasticity is the use of therapeutic intermittent theta‑burst transcranial magnetic stimulation. In the last time new metaplasticity‑based protocols are being developed in order to increase the effectiveness of this technique. These protocols consist of several stimulation sessions in a day with an interval between sessions. However, there is no experience of use of such protocols in spasticity so far.Aim. To assess the safety and tolerability as well as provide first evidence of anti‑spastic effects of an original meta-plasticity‑based intermittent theta‑burst stimulation protocol in patients with progressive multiple sclerosis and spasticity.Materials and methods. In total, 5 patients with progressive multiple sclerosis and spasticity (2 females and 3 males, 28–53 y. o., disease duration – 11–18 years, EDSS – 6.5–8.5 points) were included into the study. 3 sessions of stimulation separated by an interval of 1 hour were applied daily, where a single session consisted of 3 protocols of theta‑burst stimulation with standard duration. Stimulation target was the area of cortical representation of the leg muscles, stimulation was applied consequently to both sides during 5 days (15 sessions in total). Before and after the treatment course anti‑spastic effect (modified Ashworth scale) as well as spasticity‑related pain, fatigue and clinical global impression were assessed.Results. No serious adverse events were observed during the study. Mild adverse events (sleepiness, pain at the stimulation site) developed in some cases, which did not affect patients’ willing to continue participation in the study. After the stimulation course decrease in spasticity in the legs was registered in 4 of 5 patients (to 12–39 % from the basic level). Decrease of fatigue (4 / 5) and pain severity (3 / 5) was also observed.Conclusion. According to the first experience, the proposed original metaplasticity‑based transcranial magnetic stimulation protocol is safe, well‑tolerable and potentially effective in patients with progressive multiple sclerosis. Therefore the further investigation of the protocol in a randomized controlled study seems justified.