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Abstract Details

Repetitive transcranial magnetic stimulation with the H-coil combined with intensive rehabilitation to improve gait in people with Multiple Sclerosis: a randomized controlled trial
Multiple Sclerosis
S19 - MS Biomarkers and Symptom Management (2:24 PM-2:36 PM)
008
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment for several pathological conditions affecting the central nervous system, with reported beneficial effects on brain plasticity mechanisms. Pilot studies point to the possibility to improve motor function and spasticity in people with Multiple Sclerosis by rTMS targeting the lower limb, particularly when coupled with rehabilitation.
To test whether repetitive transcranial magnetic stimulation (rTMS) to the lower limb with the H-coil, coupled with intensive neurorehabilitation, improves gait features compared with sham rTMS.

Study design: randomized, double blind, sham-controlled study. Study population: people with progressive MS and walking impairment (10 meter walk test > 10 sec). Methods: 11 sessions of high-frequency rTMS over 3 weeks, following 2-daily neurorehabilitation sessions. Primary outcomes: improvement at the 10 meters and 6 minutes walking tests; secondary (ongoing analysis): disability, modified Ashworth scale for spasticity, numeric rating scales for pain and spasticity, paced auditory serial addition test, nine-Hole Peg Test, fatigue severity scale-FSS, 12-item MS walking scale, at baseline and weekly up to Week 3.
Of the 109 patients recruited, 100 patients completed the treatment (6 drop-outs in real, 3 in sham group). A significant effect for the primary outcomes was found favouring real rTMS (mixed effect model 10MWT: p=0.02, estimate -0.93 sec; 6MWT: p=0.003, estimate +5.67). Safety: no serious adverse events have been reported; 2 patients reported transient headache and dizziness at the end of rTMS session.
The present findings provides Class I evidence on the advantage of real rTMS over sham rTMS, in a randomized, sham-controlled, double blind study, in people with progressive MS undergoing intensive neurorehabilitation. Further studies are granted to explore the most effective and efficient treatment schedule and dose, and the possible factors helping to identify the best candidate for this combined treatment strategy for gait impairment in people with progressive MS.
Authors/Disclosures
Letizia M. Leocani, MD (University Vita-Salute San Raffaele, INSPE)
PRESENTER 		Dr. Leocani has received personal compensation in the range of $0-$499 for serving as a Consultant for Roche . Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Med-ex learning.
Simone Guerrieri, MD (San Raffaele Hospital - Vita-Salute San Raffaele University) Dr. Guerrieri has nothing to disclose.
Marco Pisa, MD (Nuffield Department of Clinical Neurosciences, University of Oxford) Dr. Pisa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.
Gloria Dalla Costa No disclosure on file
Marco Rovaris No disclosure on file
Giancarlo Comi, MD (University Vita-Salute) Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Janssen. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Aspen Healthcare. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Sanofi. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Rewind.