Objective: The present study investigated the efficacy and safety of combination treatment of repetitive transcranial magnetic stimulation (rTMS) and physical therapy (PT) in patients with cerebellar variant of multiple system atrophy (MSA-C).
Background: Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation that influences the neural excitability of focal brain areas, and previous studies revealed rTMS of the cerebellum alleviated ataxia symptoms in patients with cerebellar ataxia. rTMS not only have some beneficial effects on cerebellar ataxia, but also can help to augment motor training-induced plasticity. Given this situation, combination treatment with rTMS and intensive physical therapy (rTMS+PT) may have a synergic effect on improving cerebellar ataxia.
Method: We recruited subjects with MSA-C, randomized into 2 groups (rTMS+PTMSA and controlMSA groups), and those with genetically confirmed spinocerebellar ataxia (rTMS+PTSCA group). Ten sessions of cerebellar rTMS and PT were performed in both rTMS+PTMSA and rTMS+PTSCA group for 2 weeks. Clinical scales were assessed at the baseline and, immediately, 4 and 12 weeks after the intervention in all enrolled subjects, and objective gait and balance analysis at the baseline and after the intervention in rTMS+PTMSA and rTMS+PTSCA groups. All the evaluations were performed by blinded raters.
Results: A total of 34 subjects with MSA (14 for rTMS+PTMSA and 20 for controlMSA group) and 8 for rTMS+PTSCA group were enrolled. In rTMS+PTMSA group, cerebellar ataxia improved after the intervention both in clinical scale and objective evaluation unlike controlMSA group, and the benefit in clinical scale lasted until 12 weeks after treatment. Additionally, depression also improved in the rTMS+PTMSA group while no change in cognition and ADL. In rTMS+PTSCA group, ataxia improved in clinical scale, but no significant change in gait and balance analysis unlike rTMS+PTMSA group. For safety, there was no subject with adverse effects in our study.
Conclusion: This preliminary study suggests that the combination of rTMS and PT could be effective and safe treatment option to control cerebellar ataxia in MSA-C.
To cite this abstract in AMA style:J.H. Ahn, J. Song, M. Kim, J.K. Mun, J.S. Kim, J.W. Cho, W.H. Chang, J. Youn. Effect of repetitive transcranial magnetic stimulation with intensive physical therapy in cerebellar ataxia: A pilot study [abstract]. Mov Disord. 2020; 35 (suppl 1). https://www.mdsabstracts.org/abstract/effect-of-repetitive-transcranial-magnetic-stimulation-with-intensive-physical-therapy-in-cerebellar-ataxia-a-pilot-study/. Accessed December 1, 2023.
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