Improvement of spasticity following intermittent theta burst stimulation in multiple sclerosis is associated with modulation of resting-state functional connectivity of the primary motor cortices

Boutière, Clémence; Rey, C.; Zaaraoui, Wafaa; Troter, Arnaud Le; Rico, Audrey; Crespy, Lydie; Achard, Sophie; Reuter, Françoise; Pariollaud, Fanelly; Wirsich, Jonathan; Asquinazi, P.; Confort‐Gouny, Sylviane; Soulier, Elisabeth; Guye, Maxime; Pelletier, Jean; Ranjeva, Jean‐Philippe; Audoin, Bertrand

doi:10.1177/1352458516661640

Cited by 49 publications

(83 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Boutière et al . showed that 10 sessions of iTBS resulted in a statistically significant change in interhemispheric connectivity with a correlation with the severity of the antispastic effect .…”

Section: Discussionmentioning

confidence: 98%

“…It has been shown that HF-rTMS leads to inhibition of the Hreflex, which may be due to an increase in presynaptic inhibition of Ia afferents [6]. Bouti ere et al [16] showed that 10 sessions of iTBS resulted in a statistically significant change in interhemispheric connectivity with a correlation with the severity of the antispastic effect [13].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

High‐frequency repetitive transcranial magnetic stimulation and intermittent theta‐burst stimulation for spasticity management in secondary progressive multiple sclerosis

Korzhova

Bakulin

Синицын

et al. 2019

Euro J of Neurology

104

View full text Add to dashboard Cite

Background and purpose The spasticity phenomenon is a significant factor in the development of disability. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment method for this disorder. Our aim was to compare the effects of two protocols of rTMS – the high‐frequency (HF) rTMS (20 Hz) and the intermittent theta‐burst stimulation (iTBS) – on the level of spasticity and concomitant symptoms in patients with secondary progressive multiple sclerosis with an analysis of the duration of the effects up to 12 weeks after the stimulation course. Methods Thirty‐four patients with secondary progressive multiple sclerosis and lower spastic paraparesis were randomized into three groups: (i) HF‐rTMS (20 Hz); (ii) iTBS; (iii) sham stimulation. Spasticity and spasticity‐associated symptoms were assessed by the Modified Ashworth Scale, the Subjective Evaluating Spasticity Scale (SESS), the numerical analog scale, the Modified Fatigue Impact Scale and the pain level scale. Results The Modified Ashworth Scale was significantly reduced after the stimulation course in the HF‐rTMS and iTBS groups. The SESS was reduced post‐intervention and at the two follow‐ups in the iTBS group, whilst HF‐rTMS produced an SESS reduction only at the 2‐week follow‐up, with no effects in the sham group. Conversely, reduction in pain and fatigue was found in the HF‐rTMS group. Conclusions The results show that HF‐rTMS and iTBS significantly reduce spasticity measured by the Modified Ashworth Scale, in contrast to sham stimulation. Some evidence was found in favor of a longer‐lasting effect of iTBS on the SESS and of a reduction in pain and fatigue after HF‐rTMS.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

High‐frequency repetitive transcranial magnetic stimulation and intermittent theta‐burst stimulation for spasticity management in secondary progressive multiple sclerosis

Korzhova

Bakulin

Синицын

et al. 2019

Euro J of Neurology

104

View full text Add to dashboard Cite

show abstract

“…The postulated pathophysiology of spasticity is that lesions of upper motor neuron impair the supraspinal inhibitory inputs, leading to an increased excitability of α and γ motor neurons, and of the interneurons at the spinal level, ultimately causing spasticity [34,35]. Therefore, facilitatory rTMS and iTBS had been applied to lower spasticity in patients with a number of neurologic disorders [20,33,[36][37][38][39][40][41] by modulating the excitability of cortical motor neurons. In addition, it is increasingly accepted that iTBS may modulate cortical excitability by inducing the long-term potential-like (LTP-like) plasticity changes [10,42,43], and the persistently increasing neural activity may project to inhibitory corticospinal synapses.…”

Section: Discussionmentioning

confidence: 99%

Augmented Efficacy of Intermittent Theta Burst Stimulation on the Virtual Reality-based Cycling Training for Upper Limb Function in Patients With Stroke

Chen

Huang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Virtual reality and arm cycling have been reported as effective treatment to improve upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb motor function in patients with stroke.Methods: In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures, including Modified Ashworth Scale Upper Extremity (MAS-UE), Fugl-Meyer Assessment Upper Extremity (FMA-UE) for body function, Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL) for activity and Stroke Impact Scale (SIS) for participation were assessed before and after the intervention. Paired t test was performed to evaluate the effectiveness after the intervention and analysis of covariance (ANCOVA) was conducted to compare the therapeutic effects between two groups.Results: At post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. ANCOVA revealed that the iTBS group presented greater improvement than the sham group significantly in MAS-UE, NHPT and SIS, and with borderline significance in ARAT, BBT and MAL. There was no significant difference in FMA-UE between groups.Conclusions: Intermittent TBS showed augmented efficacy on VCT for reducing spasticity, improving gross motor function and manual dexterity, and increasing participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb motor function recovery, especially manual dexterity, in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy.Trial registration: This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017.

show abstract

“…PubMed search identified 12 references regarding repetitive magnetic stimulation. In total, five studies [51][52][53][54][55] fulfilled the inclusion criteria for this review. Four major outcomes were used in the studies: the MAS [51][52][53][54], the AS [55], the MSSS-88 [54] and the spasticity VAS [51].…”

Section: Repetitive Transcranial Magnetic Stimulation (Rtms)mentioning

confidence: 99%

“…In total, five studies [51][52][53][54][55] fulfilled the inclusion criteria for this review. Four major outcomes were used in the studies: the MAS [51][52][53][54], the AS [55], the MSSS-88 [54] and the spasticity VAS [51]. Three study designs were double-blind sham-controlled, randomized controlled trials [51,54,55] and two were pseudo-randomized sham-controlled studies [52,53].…”

Section: Repetitive Transcranial Magnetic Stimulation (Rtms)mentioning

confidence: 99%

Italian consensus on treatment of spasticity in multiple sclerosis

Comi

Solari

Leocani

et al. 2019

Euro J of Neurology

View full text Add to dashboard Cite

Background Spasticity is a frequent multifactorial manifestation of multiple sclerosis (MS), affecting mostly the chronic courses of the disease. Its impact on patient functioning and quality of life is profound. Treatment of spasticity includes oral and intrathecal anti‐spastic drugs, muscle injections with relaxant agents, physical therapy, electrical and magnetic stimulation and peripheral nerve stimulation, alone or in various combinations. Methods This Italian consensus on the treatment of spasticity in MS was produced by a large group of Italian MS experts in collaboration with neurophysiologists, experts in the production of guidelines and patients’ representatives operating under the umbrella of the Italian Neurological Society, the Associazione Italiana Sclerosi Multipla and the European Charcot Foundation. This guideline was developed in accordance with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A total of 11 questions were formulated following the PICO framework (patients, intervention, comparator, outcome). Controlled studies only were included in the analysis. Results Despite some consistent limitations due to the poor methodological quality of most studies, there was a consensus on a strong recommendation for the use of intrathecal baclofen, oromucosal spray of nabiximols and intramuscular injection of botulinum toxin. The level of recommendation was weak for oral baclofen, tizanidine, gabapentin, benzodiazepines and transcranial magnetic stimulation. Conclusions There is a clear need for new larger multicentre well‐designed clinical trials with a duration that allows the persistence of the effects and the long‐term safety of the interventions to be evaluated.

show abstract

Improvement of spasticity following intermittent theta burst stimulation in multiple sclerosis is associated with modulation of resting-state functional connectivity of the primary motor cortices

Abstract: This longitudinal resting-state fMRI study evidences that functional reorganization of the primary motor cortices may underlie the effect of iTBS on spasticity in MS.

Cited by 49 publications

References 29 publications

High‐frequency repetitive transcranial magnetic stimulation and intermittent theta‐burst stimulation for spasticity management in secondary progressive multiple sclerosis

High‐frequency repetitive transcranial magnetic stimulation and intermittent theta‐burst stimulation for spasticity management in secondary progressive multiple sclerosis

Augmented Efficacy of Intermittent Theta Burst Stimulation on the Virtual Reality-based Cycling Training for Upper Limb Function in Patients With Stroke

Italian consensus on treatment of spasticity in multiple sclerosis

Contact Info

Product

Resources

About