Cerebellar High-Frequency rTMS in Balance of Multiple Sclerosis Patients

Background: Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system (CNS), leading to progressive motor dysfunction and balance deficits. Although disease-modifying therapies have advanced, there remains an unmet need for effective treatments that target motor and cognitive impairments. Objective: To investigate the impact of cerebellar rTMS in improving postural control, balance performance, and functional ambulation in individuals with MS. Method: This randomized, single-blinded, placebo-controlled clinical trial evaluated the efficacy of repetitive transcranial magnetic stimulation (rTMS) over the cerebellum in improving motor function and balance in 40 MS patients. Outcome measures, including the Expanded Disability Status Scale (EDSS), static posturography (COP measures), the International Cooperative Ataxia Rating Scale (ICARS), and the 10-Meter Walk Test (10MWT), were assessed before and after intervention.

Inclusion criteria

• Patient age ≥18 years.
• Patients with MS, established by clinical, laboratory, MRI criteria and matched Mc Donald's criteria, McDonald et al, 2006.
• Expanded Disability Status Scale (EDSS) scores between 2.5-5
• Only patients in "remitting" phase were included.
• Informed consent.

Exclusion criteria

• Factors that prevent patient cooperation understanding that impede proper study participation.
• Disabling medical history as severe or recent heart disease and or severe head trauma.
• Cognitive impairment: <24 points by mini-mental scale. (Folstein MF et al., 1975).
• Diabetic patients.
• Patients with any other comorbidity that can affect balance, e.g, other neurological diseases that can affect posterior column function.
• Contraindications for rTMS:

• History of epilepsy.
• Metal (implants) in skull/scalp/head or fragments from welding or metalwork.
• Implanted device (as spinal cord stimulator, cardiac pacemaker, and cochlear implants).
• Pregnancy.