The motor cortex (MC) receives an excitatory input from the cerebellum which is reduced in patients with cerebellar lesions. High-frequency repetitive transcranial magnetic stimulation (rTMS) induces cortical facilitation which can counteract the reduced cerebellar drive to the MC. Our study included 24 relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients with dysmetria. The patients were divided into two groups: Group A received two sessions of real MC rTMS and Group B received one session of real rTMS and one session of sham rTMS. Ten healthy volunteers formed group C. Evaluation was carried out using the nine-hole pegboard task and the cerebellar functional system score (FSS) of the expanded disability status scale (EDSS). Group A patients showed a significant improvement in the time required to finish the pegboard task (P = 0.002) and in their cerebellar FSS (P = 0.000) directly after the second session and 1 month later. The RRMS patients showed more improvement than the SPMS patients. Group B patients did not show any improvement in the pegboard task or the cerebellar FSS. These results indicate that MC rTMS can be a promising option in treating both RRMS or SPMS patients with cerebellar impairment and that its effect can be long-lasting.

Sleep apnea is frequent in patients with epilepsy. OSA may contribute to increase seizure frequency. We recommend investigating sleep apnea in all patients with epilepsy.

Background: High-resolution ultrasonography (US) is a non-invasive, readily applicable imaging modality capable of depicting real-time static and dynamic information concerning the peripheral nerves and their surrounding tissues. Although electrophysiological studies are the gold standard in the evaluation of nerve injuries, US can be used also to evaluate the morphological changes of nerve injuries. Objectives: To evaluate the role of the high-resolution US in the assessment of nerve injuries and to compare it to the role of electrodiagnostic studies. Subjects and methods: A total of 30 nerves from 22 consecutive patients with clinically definite nerve injury were considered. Two independent and blinded clinicians perform electrodiagnosis and US. The clinical, neurophysiological, and US findings were collected, and the contribution of US was then classified as " contributive" or "non-contributive", according to whether US confirmed the clinical and neurophysiological diagnosis or not. Results: US was "contributive" (confirming the electrophysiological diagnosis) in 66.67% of cases (n = 20), providing information about continuity of the nerve, morphological changes after injury as swelling, scar tissue formation, or neuroma formation with sensitivity of 75% compared to the electrodiagnostic studies and accuracy of 66.67%. Conclusion: Ultrasound can be used, when available, as a complementary tool for electrodiagnostic studies to provide anatomical information about the injured nerves in case of complete axonal lesion.

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