Comparing the efficacy of different types of repetitive navigated transcranial magnetic stimulation in treatment of pharmacoresistant spasticity in patients with multiple sclerosis: 20Hz rTMS, iTBS or placebo

Background: Spasticity is a significant factor in the development of disability. Transcranial magnetic stimulation (TMS) can be a promising tool for treatment. Introduction: Our aim was to assess the efficacy of navigated repetitive TMS (rTMS) in modulating lower limb spasticity. Methods: 13 patients (6 males, 7 females, mean age 45,64 +/‐ 11,47 years) with secondary progressive multiple sclerosis and lower spastic paraparesis received 10 sessions of two different types of rTMS or sham‐stimulation over the motor hotspot of the tibialis anterior muscle (table 1). We assessed Modified Ashworth Scale (MAS), Modified Fatigue Impact Scale 2 (MFIS 2), Expanded disability status scale (EDSS), and Spasticity Subjective Evaluation Scale (SSES), pain level scale, dysfunction of the pelvic organs before, at the end of rTMS session, 2 and 12 weeks after. Results: Patients who underwent both types of rTMS sessions showed a reduction of spasticity on MAS (table 2). There was no significant reduction of spasticity on MAS in placebo group. There was significant reduction of spasticity on SSES after iTBS protocol. This effect persisted for 12 weeks in most patients. In 20Hz and placebo group there were no significant changes on SSES. After stimulation in all 3 groups we noticed no significant differences in influence on fatigue (MFIS2), pain level, dysfunction of the pelvic organs. Conclusion: Our results indicate evident efficacy of both types of rTMS in treatment of severe spasticity. We noticed that iTBS reduce spasticity more pronounced and for longer time. Further trials will help us to indicate it more accurate. (Table Presented).