Peripheral magnetic theta burst stimulation to muscles can effectively reduce spasticity: a randomized controlled trial

Abstract

Background Spasticity is a common complication of many neurological diseases and despite contributing much disability; the available therapeutic options are limited. Peripheral magnetic stimulation is one promising option. In this study, we investigated whether peripheral intermittent theta burst stimulation (piTBS) will reduce spasticity when applied directly on spastic muscles. Methods In this sham-controlled study, eight successive sessions of piTBS were applied directly to spastic muscles with supra threshold intensity. Assessment was done by modified Ashworth scale (mAS) and estimated Botulinum toxin dose (eBTD) at baseline and after the 8th session in both active and sham groups. Results A total of 120 spastic muscles of 36 patients were included in the analysis. Significant reduction of mAS and eBTD was found in the active compared to sham group (p < 0.001). The difference in mAS was also significant when tested in upper limb and lower limb subgroups. The degree of reduction in mAS was positively correlated with the baseline scores in the active group. Conclusion piTBS could be a promising method to reduce spasticity and eBTD. It consumes less time than standard high frequency protocols without compromising treatment efficacy. Trial registration: Clinical trial registry number: PACTR202009622405087. Retrospectively Registered 14th September, 2020.

Effects of repetitive peripheral magnetic stimulation on spasticity evaluated with modified Ashworth scale/Ashworth scale in patients with spastic paralysis: A systematic review and meta-analysis

“…As no difference among the results of risk of bias for each outcome assessed in per study, the main outcome of the current review was selected to present in the Figure 3 . Overall, one study ( 19 ) was assessed to be of high risk of bias and two ( 20 , 21 ) had some concerns, the others were at low risk of bias ( 22 – 26 ). Most of studies described a random sequence clearly, only one study ( 19 ) has high risk in randomization process.…”

“…The number of sessions of rPMS in all included studies ranged from 1 to 20. Three studies ( 19 , 24 , 25 ) used single session, whereas the other five studies ( 20 – 23 , 26 ) adopted multiple treatments with 6 to 20 sessions delivered in 8 days to 2 weeks. Five studies ( 19 , 20 , 22 , 24 , 26 ) directly compared rPMS with sham stimulation, and three ( 21 , 23 , 25 ) assessed the effects of rPMS plus conventional treatment including passive stretch ( 25 ), proprioceptive neuromuscular facilitation ( 21 , 23 ), and neuromuscular electrical for spasticity.…”

“…The overall risk of bias of the eight included studies are summarized in Figure 2, and the assessment results of the five domains and the overall bias for individual studies are shown in As no difference among the results of risk of bias for each outcome assessed in per study, the main outcome of the current review was selected to present in the Figure 3. Overall, one study (19) was assessed to be of high risk of bias and two (20,21) had some concerns, the others were at low risk of bias (22)(23)(24)(25)(26). Most of studies described a random sequence clearly, only one study (19) has high risk in randomization process.…”

“…After a series of literature screening and qualification confirmation, eight RCTs (19)(20)(21)(22)(23)(24)(25)(26) were selected for systematic review, and six were presented in the form of a metaanalysis. Table 1 summarizes the characteristics of the included studies and patients with spastic paralysis.…”

“…The number of sessions of rPMS in all included studies ranged from 1 to 20. Three studies (19,24,25) used single session, whereas the other five studies (20)(21)(22)(23)26) Group A = 47.9 ± 8.5…”