scholarly journals Transcranial Magnetic Stimulation as a Potential Biomarker in Multiple Sclerosis: A Systematic Review with Recommendations for Future Research

2019 ◽  
Vol 2019 ◽  
pp. 1-22 ◽  
Author(s):  
Nicholas J. Snow ◽  
Katie P. Wadden ◽  
Arthur R. Chaves ◽  
Michelle Ploughman
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Transcranial Magnetic Stimulation ◽  
Disease Severity ◽  
Magnetic Stimulation ◽  
Motor Impairment ◽  
Risk Of Bias ◽  
Future Research ◽  
Conduction Time ◽  
Potential Biomarker

Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system. Disease progression is variable and unpredictable, warranting the development of biomarkers of disease status. Transcranial magnetic stimulation (TMS) is a noninvasive method used to study the human motor system, which has shown potential in MS research. However, few reviews have summarized the use of TMS combined with clinical measures of MS and no work has comprehensively assessed study quality. This review explored the viability of TMS as a biomarker in studies of MS examining disease severity, cognitive impairment, motor impairment, or fatigue. Methodological quality and risk of bias were evaluated in studies meeting selection criteria. After screening 1603 records, 30 were included for review. All studies showed high risk of bias, attributed largely to issues surrounding sample size justification, experimenter blinding, and failure to account for key potential confounding variables. Central motor conduction time and motor-evoked potentials were the most commonly used TMS techniques and showed relationships with disease severity, motor impairment, and fatigue. Short-latency afferent inhibition was the only outcome related to cognitive impairment. Although there is insufficient evidence for TMS in clinical assessments of MS, this review serves as a template to inform future research.

scholarly journals Clinical, Neurophysiological, and MRI Markers of Fampridine Responsiveness in Multiple Sclerosis—An Explorative Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sepehr Mamoei ◽  
Henrik Boye Jensen ◽  
Andreas Kristian Pedersen ◽  
Mikkel Karl Emil Nygaard ◽  
Simon Fristed Eskildsen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Longitudinal Study ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Motor Evoked Potentials ◽  
Step Test ◽  
Conduction Time ◽  
Lesion Load ◽  
Clinical Trial Registration ◽  
Peripheral Motor

Objective: Persons with multiple sclerosis (PwMS), already established as responders or non-responders to Fampridine treatment, were compared in terms of disability measures, physical and cognitive performance tests, neurophysiology, and magnetic resonance imaging (MRI) outcomes in a 1-year explorative longitudinal study.Materials and Methods: Data from a 1-year longitudinal study were analyzed. Examinations consisted of the timed 25-foot walk test (T25FW), six spot step test (SSST), nine-hole peg test (9-HPT), five times sit-to-stand test (5-STS), symbol digit modalities test (SDMT), transcranial magnetic stimulation (TMS) elicited motor evoked potentials (MEP) examining central motor conduction times (CMCT), peripheral motor conduction times (PMCT) and their amplitudes, electroneuronography (ENG) of the lower extremities, and brain structural MRI measures.Results: Forty-one responders and eight non-responders to Fampridine treatment were examined. There were no intergroup differences except for the PMCT, where non-responders had prolonged conduction times compared to responders to Fampridine. Six spot step test was associated with CMCT throughout the study. After 1 year, CMCT was further prolonged and cortical MEP amplitudes decreased in both groups, while PMCT and ENG did not change. Throughout the study, CMCT was associated with the expanded disability status scale (EDSS) and 12-item multiple sclerosis walking scale (MSWS-12), while SDMT was associated with number of T2-weighted lesions, lesion load, and lesion load normalized to brain volume.Conclusions: Peripheral motor conduction time is prolonged in non-responders to Fampridine when compared to responders. Transcranial magnetic stimulation-elicited MEPs and SDMT can be used as markers of disability progression and lesion activity visualized by MRI, respectively.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03401307.

scholarly journals Evaluation and Treatment of Vascular Cognitive Impairment by Transcranial Magnetic Stimulation

2020 ◽  
Vol 2020 ◽  
pp. 1-17
Author(s):  
Mariagiovanna Cantone ◽  
Giuseppe Lanza ◽  
Francesco Fisicaro ◽  
Manuela Pennisi ◽  
Rita Bella ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Synaptic Plasticity ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Disease Process ◽  
Vascular Cognitive Impairment ◽  
Future Research ◽  
Disease Modifying Drugs

The exact relationship between cognitive functioning, cortical excitability, and synaptic plasticity in dementia is not completely understood. Vascular cognitive impairment (VCI) is deemed to be the most common cognitive disorder in the elderly since it encompasses any degree of vascular-based cognitive decline. In different cognitive disorders, including VCI, transcranial magnetic stimulation (TMS) can be exploited as a noninvasive tool able to evaluate in vivo the cortical excitability, the propension to undergo neural plastic phenomena, and the underlying transmission pathways. Overall, TMS in VCI revealed enhanced cortical excitability and synaptic plasticity that seem to correlate with the disease process and progression. In some patients, such plasticity may be considered as an adaptive response to disease progression, thus allowing the preservation of motor programming and execution. Recent findings also point out the possibility to employ TMS to predict cognitive deterioration in the so-called “brains at risk” for dementia, which may be those patients who benefit more of disease-modifying drugs and rehabilitative or neuromodulatory approaches, such as those based on repetitive TMS (rTMS). Finally, TMS can be exploited to select the responders to specific drugs in the attempt to maximize the response and to restore maladaptive plasticity. While no single TMS index owns enough specificity, a panel of TMS-derived measures can support VCI diagnosis and identify early markers of progression into dementia. This work reviews all TMS and rTMS studies on VCI. The aim is to evaluate how cortical excitability, plasticity, and connectivity interact in the pathophysiology of the impairment and to provide a translational perspective towards novel treatments of these patients. Current pitfalls and limitations of both studies and techniques are also discussed, together with possible solutions and future research agenda.

scholarly journals Motor disability in patients with multiple sclerosis: transcranial magnetic stimulation study

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Anssam Bassem Mohy ◽  
Aqeel Kareem Hatem ◽  
Hussein Ghani Kadoori ◽  
Farqad Bader Hamdan
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Motor Evoked Potential ◽  
Invasive Procedure ◽  
Single Pulse ◽  
Lower Limbs ◽  
Control Group ◽  
Conduction Time ◽  
Motor Disability

Abstract Background Transcranial magnetic stimulation (TMS) is a non-invasive procedure used in a small targeted region of the brain via electromagnetic induction and used diagnostically to measure the connection between the central nervous system (CNS) and skeletal muscle to evaluate the damage that occurs in MS. Objectives The study aims to investigate whether single-pulse TMS measures differ between patients with MS and healthy controls and to consider if these measures are associated with clinical disability. Patients and methods Single-pulse TMS was performed in 26 patients with MS who hand an Expanded Disability Status Scale (EDSS) score between 0 and 9.5 and in 26 normal subjects. Different TMS parameters from upper and lower limbs were investigated. Results TMS disclosed no difference in all MEP parameters between the right and left side of the upper and lower limbs in patients with MS and controls. In all patients, TMS parameters were different from the control group. Upper limb central motor conduction time (CMCT) was prolonged in MS patients with pyramidal signs. Upper and lower limb CMCT and CMCT-f wave (CMCT-f) were prolonged in patients with ataxia. Moreover, CMCT and CMCT-f were prolonged in MS patients with EDSS of 5–9.5 as compared to those with a score of 0–4.5. EDSS correlated with upper and lower limb cortical latency (CL), CMCT, and CMCT-f whereas motor evoked potential (MEP) amplitude not. Conclusion TMS yields objective data to evaluate clinical disability and its parameters correlated well with EDSS.

Improvement of hand dexterity following motor cortex rTMS in multiple sclerosis patients with cerebellar impairment

2008 ◽  
Vol 14 (7) ◽  
pp. 995-998 ◽  
Author(s):  
G Koch ◽  
S Rossi ◽  
C Prosperetti ◽  
C Codecà ◽  
F Monteleone ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Transcranial Magnetic Stimulation ◽  
Motor Cortex ◽  
Healthy Subjects ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Hand Dexterity ◽  
Time Required ◽  
Multiple Sclerosis Patients ◽  
Cerebellar Symptoms

We tested the effects of 5-Hz repetitive transcranial magnetic stimulation (rTMS) over the motor cortex in multiple sclerosis (MS) subjects with cerebellar symptoms. rTMS improved hand dexterity in cerebellar patients ( n = 8) but not in healthy subjects ( n = 7), as detected by a significant transient reduction of the time required to complete the nine-hole pegboard task. rTMS of the motor cortex may be a useful approach to treat cerebellar impairment in MS patients.

Cerebellar Dysfunction in Multiple Sclerosis: Considerations for Research and Rehabilitation Therapy

2021 ◽  
pp. 154596832110654
Author(s):  
Erin M. Edwards ◽  
Nora E. Fritz ◽  
Amanda S. Therrien
Keyword(s):  
Multiple Sclerosis ◽  
Motor Control ◽  
Motor Impairment ◽  
Future Research ◽  
Disability Progression ◽  
Cerebellar Dysfunction ◽  
Motor Disability ◽  
Rehabilitation Outcomes ◽  
Critical Knowledge ◽  
The Impact

Introduction. Cerebellar pathology is common among persons with multiple sclerosis (PwMS). The cerebellum is well recognized for its role in motor control and motor learning and cerebellar pathology in multiple sclerosis is associated with enhanced motor impairment and disability progression. The Problem. To mitigate motor disability progression, PwMS are commonly prescribed exercise and task-specific rehabilitation training. Yet, whether cerebellar dysfunction differentially affects rehabilitation outcomes in this population remains unknown. Furthermore, we lack rehabilitation interventions targeting cerebellar dysfunction. The Solution. Here, we summarize the current understanding of the impact of cerebellar dysfunction on motor control, motor training, and rehabilitation in persons with multiple sclerosis. Recommendations. Additionally, we highlight critical knowledge gaps and propose that these guide future research studying cerebellar dysfunction in persons with multiple sclerosis.

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