Cerebellar Intermittent Theta-Burst Stimulation Combined with Vestibular Rehabilitation Improves Gait and Balance in Pat
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SHORT REPORTS
Cerebellar Intermittent Theta-Burst Stimulation Combined with Vestibular Rehabilitation Improves Gait and Balance in Patients with Multiple Sclerosis: a Preliminary Double-Blind Randomized Controlled Trial Marco Tramontano 1,2 & Maria Grazia Grasso 1 & Silvia Soldi 1 & Elias Paolo Casula 1 & Sonia Bonnì 1 & Sara Mastrogiacomo 1 & Alessia D’Acunto 1 & Francesco Porrazzini 1 & Carlo Caltagirone 1 & Giacomo Koch 1,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Difficulties in gait and balance disorders are among the most common mobility limitations in multiple sclerosis (MS), mainly due to a damage of cerebellar circuits. Moreover, the cerebellum plays a critical role in promoting new motor tasks, which is an essential function for neurorehabilitation. In this study, we investigated the effects of cerebellar intermittent theta burst stimulation (c-iTBS), a high-frequency rTMS protocol able to increase cerebellar activity, on gait and balance in a sample of 20 hospitalized participants with MS, undergoing vestibular rehabilitation (VR), an exercise-based program primarily designed to reduce vertigo and dizziness, gaze instability, and/or imbalance and falls in MS. Patients were assigned to receive either c-iTBS or sham iTBS before being treated with VR during 2 weeks. VR consisted of two types of training: gaze stability and postural stability exercises. The primary outcome measure was the change from baseline in the Tinetti Balance and Gait scale (TBG). The secondary outcome measures were changes from baseline in Berg Balance Scale (BBS), Fatigue Severity Scale (FSS), Two Minute Walking Test (2MWT), and Timed 25-ft walk test (T25FW) scales. MS patients treated with c-iTBS-VR showed a significant improvement in the TBG as compared to patients treated with sham iTBS-VR. Moreover, MS patients in the c-iTBS groups showed better performances in the vestibular-ocular reflex exercises. Combined c-iTBS and VR improves gait and balance abilities more than standard VR treatment in MS patients with a high level of disability. Keywords Transcranial magnetic stimulation . Multiple sclerosis . Cerebellum . Plasticity . Gait and balance . TMS
Introduction Difficulties in gait and balance disorders are among the most common motor limitations in multiple sclerosis (MS) [1]. Balance and gait problems are related to a high percentage Marco Tramontano and Maria Grazia Grasso contributed equally to this work. * Giacomo Koch [email protected] 1
Santa Lucia Foundation IRCCS, Via Ardeatina, 306, 00179 Rome, Italy
2
Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, P.zza Lauro de Bosis 15, 00135 Rome, Italy
3
eCampus University, Novedrate, Italy
of individuals with MS reporting frequent falls, which often result in injuries. A new valuable approach may be provided by vestibular rehabilitation (VR), an exercise-based program primarily designed to reduce vertigo and d
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