Use of a metaplasticity-based protocol of therapeutic transcranial magnetic stimulation in patients with progressive multiple sclerosis and spasticity: first experience
Use of a metaplasticity-based protocol of therapeutic transcranial magnetic stimulation in patients with progressive multiple sclerosis and spasticity: first experience
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使用基于化生性的经颅磁刺激治疗方案治疗进行性多发性硬化症和痉挛患者：首次经验
DOI：
10.17650/2222-8721-2022-12-3-26-35
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
M. Piradov
中科院分区：
文献类型：
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作者：
I. Bakulin;A. Poydasheva;A. Zabirova;D. Lagoda;A. A. Rimkevichus;M. Zakharova;N. Suponeva;M. Piradov
背景痉挛是一种致残性综合征，经常观察到进展性多发性硬化症。治疗痉挛的一种有前途的方法是使用治疗性间歇性theta爆发经颅磁刺激。最近，为了提高这项技术的有效性，正在开发新的基于变形性的方案。这些方案由一天中的若干刺激会话组成，会话之间具有间隔。然而，目前还没有经验使用这样的协议在痉挛。评估安全性和耐受性，并提供原始的基于亚可塑性的间歇性θ波刺激方案在进行性多发性硬化和痉挛患者中的抗痉挛作用的第一个证据。材料和方法。总共有5例进行性多发性硬化和痉挛患者（2例女性和3例男性，28-53岁）。O.的，疾病持续时间- 11-18年，EDSS - 6.5-8.5分）被包括在研究中。每天应用3个刺激会话，间隔1小时，其中单个会话由3个具有标准持续时间的θ脉冲串刺激方案组成。刺激目标是腿部肌肉的皮质代表区域，因此在5天内（共15次）对两侧施加刺激。观察治疗前后抗痉挛效果（改良Ashworth量表）以及痉挛相关疼痛、疲劳和临床总体印象。研究期间未观察到严重不良事件。在某些病例中发生了轻度不良事件（嗜睡、刺激部位疼痛），但不影响患者继续参与研究的意愿。刺激过程后，5例患者中有4例记录到腿部痉挛减轻（从基础水平降至12- 39%）。疲劳（4 / 5）和疼痛程度（3 / 5）也有所减轻。根据第一次经验，提出的基于变形性的经颅磁刺激方案是安全的，耐受性良好，对进行性多发性硬化症患者可能有效。因此，在随机对照研究中进一步研究方案似乎是合理的。
Background. Spasticity is a disabling syndrome frequently observed in progressive multiple sclerosis. One of the promising approaches to the treatment of spasticity is the use of therapeutic intermittent theta‑burst transcranial magnetic stimulation. In the last time new metaplasticity‑based protocols are being developed in order to increase the effectiveness of this technique. These protocols consist of several stimulation sessions in a day with an interval between sessions. However, there is no experience of use of such protocols in spasticity so far.Aim. To assess the safety and tolerability as well as provide first evidence of anti‑spastic effects of an original meta-plasticity‑based intermittent theta‑burst stimulation protocol in patients with progressive multiple sclerosis and spasticity.Materials and methods. In total, 5 patients with progressive multiple sclerosis and spasticity (2 females and 3 males, 28–53 y. o., disease duration – 11–18 years, EDSS – 6.5–8.5 points) were included into the study. 3 sessions of stimulation separated by an interval of 1 hour were applied daily, where a single session consisted of 3 protocols of theta‑burst stimulation with standard duration. Stimulation target was the area of cortical representation of the leg muscles, stimulation was applied consequently to both sides during 5 days (15 sessions in total). Before and after the treatment course anti‑spastic effect (modified Ashworth scale) as well as spasticity‑related pain, fatigue and clinical global impression were assessed.Results. No serious adverse events were observed during the study. Mild adverse events (sleepiness, pain at the stimulation site) developed in some cases, which did not affect patients’ willing to continue participation in the study. After the stimulation course decrease in spasticity in the legs was registered in 4 of 5 patients (to 12–39 % from the basic level). Decrease of fatigue (4 / 5) and pain severity (3 / 5) was also observed.Conclusion. According to the first experience, the proposed original metaplasticity‑based transcranial magnetic stimulation protocol is safe, well‑tolerable and potentially effective in patients with progressive multiple sclerosis. Therefore the further investigation of the protocol in a randomized controlled study seems justified.