Title : Results of a comparative study on the efficacy of transcranial magnetic stimulation in the treatment of cerebral forms of multiple sclerosis
Abstract:
Relevance. Multiple sclerosis (MS) is a chronic autoimmune neurodegenerative disease of the central nervous system characterized by the destruction of the myelin sheath and the formation of sclerotic lesions of varying sizes in brain and spinal cord tissues.
Objective: To comprehensively evaluate the efficacy of transcranial magnetic stimulation (TMS) in cerebral forms of multiple sclerosis based on clinical, neurological, and neurofunctional parameters.
Materials and Methods: Ninety patients aged 30 to 50 years with multiple sclerosis were selected for the study. The enrolled patients were divided into two groups: 45 patients with secondary progressive multiple sclerosis (main group 1) and 45 patients with primary progressive multiple sclerosis (control group 2). The efficacy of transcranial magnetic stimulation (TMS) during an exacerbation was compared. Patients in main group 1 received high-frequency (10–20 Hz) rTMS for 15 days targeting the DLPFC, M1, SMA, and occipital cortex; the procedure lasted 20 minutes per day, 5 days a week, with 2 days of rest. Patients in the second control group underwent low-frequency (≤5 Hz) rTMS stimulation at the DLPFC and S1 sites for 15 days to address severe anxiety, restlessness, and sensory disturbances, as well as high-frequency (10–20 Hz) rTMS at the M1 sites (R-M1 and L-M1) to reduce spasticity. The procedure was administered for 20 minutes daily, 5 days a week, with 2 days of rest. Outcomes were assessed after 25 days. The severity of neurological disorders and the efficacy of TMS treatment were evaluated using the Expanded Disability Status Scale (EDSS).
Results: Pre-treatment neurological severity scores on the EDSS were 6.4 ± 2.5 in Group 1 and 6.2 ± 2.0 in Group 2. After fifteen days, the severity of clinical disorders decreased by 3.6 points in Group 1 (p<0.001) and by 4.2 points in the control group (p<0.05). Thus, disability levels decreased significantly in both groups according to the EDSS, but the positive changes in Group 1 demonstrated greater efficacy. A comparison of the final results showed that the level of functional recovery in Group 1 was 1.16 times higher than in Group 2 (p<0.01).
Conclusion: TMS treatment for multiple sclerosis is more effective than traditional rehabilitation and reduces the need for various muscle relaxants, sedatives, and antidepressants. Most importantly, it significantly reduces the level of disability, has a positive effect on the recovery of neurological functions, and thereby contributes to improving the patient's quality of life.
