108. Corticospinal reserve predicts walking improvement after intensive rehabilitation and deep rTMS with H-coil in progressive multiple sclerosis

• Published in: Clinical neurophysiology 2015-01, Vol.126 (1), p.e25-e25
• Main Authors: Nuara, A, Saraceno, L, Houdayer, E, Chieffo, R, Di Maggio, G, Coppi, E, Fichera, M, Martinelli-Boneschi, F, Esposito, F, Zangen, A, Comola, M, Comi, G, Leocani, L
• Format: Article
• Language: English
• Subjects: Neurology
• ISSN: 1388-2457; 1872-8952
• DOI: 10.1016/j.clinph.2014.10.127

High frequency transcranial repetitive magnetic stimulation (rTMS) enhances corticospinal excitability and plasticity, potentially favouring the effects of neurorehabilitation, as in a preliminary study by our group. We aimed at replicating our previous study and at combining results exploring baseline features. Twenty subjects with progressive MS, randomized in real and sham-placebo H-coil rTMS targeting lower limbs, underwent 11 sessions following intensive rehabilitation. Walking speed (10MWT), endurance (6 min test), modified Ashworth Scale-MAS, numeric rating scale-NRS for spasticity and pain, EDSS, PASAT, NHPT, Fatigue Severity Scale, MS walking scale-12, were assessed at baseline and end of treatment. Real rTMS had significant improvement in 10MWT and MAS vs sham, confirming data from a previous pilot study on 21 participants. Pooling data with the latter study, a correlation between resting motor threshold to the lower limb and walking improvement was found exclusively in the real rTMS group. The improvement in walking speed observed after real rTMS with the H-coil is consistent with data from our previous pilot study. Resting motor threshold could be considered as a specific therapeutic reserve index for rTMS, being predictive of therapeutic response to corticospinal neuromodulation.