Effect of Repetitive Transcranial Magnetic Stimulation on Motor Functions in Multiple Sclerosis Patients:A Randomized Controlled Trial

Background: Multiple sclerosis (MS) is a chronic disease in the central nervous system which causes a number of physical symptoms including impairments of motor functions. Purpose: to investigate the effect of low frequency repetitive transcranial magnetic stimulation (LF-rTMS) on motor functions in multiple sclerosis patients.

Methods: Thirty medically stable remitting relapsing MS patients aged between 20-40 years were randomly assigned into two groups ("A" study and "B" control). Both groups were treated with a selected physical therapy program consisting of graduated active exercises, balance and gait training, but only group "A" received (LF-rTMS) ipsilateral to the weaker lower limb, five times per week for two consecutive weeks. Isokinetic dynamometer measurements including peak torque (PT), peak torque/body weight (PT/BW), time to peak torque (TPT), total work (TW) and average power (AP) of knee flexors and extensors plus lower extremity functional performance were measured and compared for both groups before and after intervention using biodex isokinetic dynamometer and Five Repetition Sit to Stand Test (5STS) respectively.

Results: Comparison of the mean values of isokinetic dynamometer measurements post-treatment between both groups showed significant difference of ( PT, PT/BW, TPT) in favor of group A (P ≤ 0.05) but no considerable variations were reported among both groups concerning (TW, AP) (P > 0.05). Comparison of the mean values of (5STS) post-treatment between both groups showed significant difference in favor of group A (P ≤ 0.05). Correlation results revealed significant correlation between the tested Isokinetic dynamometer measurements and (5STS).

Conclusion: low frequency repetitive transcranial magnetic stimulation could improve motor functions and subsequent functional performance in multiple sclerosis patients.