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April2013 Vol.50 Issue:        2        Table of Contents
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Repetitive Transcranial Magnetic Stimulation Effect in Multiple Sclerosis Spasticity (Clinical and Electrophysiological evaluation): A preliminary Egyptian Study

Ann A. Abdelkader1, Hatem Samir2, Reem El-Hadidy1, Noha El-Sawy1

Departments of Clinical Neurophysiology1, Neurology2; Cairo University; Egypt 


Background: Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique that induces cortical excitability changes at the stimulation and distant sites, leading to either facilitation or inhibition depending on the pulse frequency. These effects may outlast the train of stimulus duration, for minutes or even hours. Repetitive TMS may improve spasticity in multiple sclerosis (MS) especially that the current pharmacologic treatment of spasticity has side effects like sedation, weakness and cognitive disturbances. Hyperexcitability of the stretch reflex arc, secondary to lesion of the corticospinal tract, is considered a possible mechanism at the basis of spasticity. Objective: To investigate whether high and low frequency (rTMS) can modify MS spasticity assessed by clinical and electrophysiological scales. Methods: 21 relapsing-remitting (RRMS) patients with lower limb spasticity underwent (rTMS) of high (5Hz) and low (1Hz) frequency treatment protocols lasting 2weeks over the leg primary motor cortex. Spasticity was assessed using clinical scales (Tardieu and modified Ashworth scales) and neurophysiological H/M amplitude ratio of the soleus H reflex. Results: Our study showed that (5Hz) rTMS increased H/M amplitude ratio with significant improvement of the lower limb spasticity scales, while the (1Hz) rTMS sessions showed no improvement of H/M ratio as well as the spasticity scales. Conclusion: (5Hz) rTMS can contribute in improving the MS spasticity and hence improving quality of patients' life. [Egypt J Neurol Psychiat Neurosurg.  2013; 50(2): 157-162]

 Key Words: Repetitive transcranial stimulation, multiple sclerosis, spasticity, H/M ratio.  

Correspondence to Ann A. Abdelkader, Department of Clinical Neurophysiology, Egypt. Tel.: +201006063114. Email:

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