Use of a metaplasticity-based protocol of therapeutic transcranial magnetic stimulation in patients with progressive multiple sclerosis and spasticity: first experience

Background . Spasticity is a disabling syndrome frequently observed in progressive multiple sclerosis. One of the promising approaches to treatment spasticity use therapeutic intermittent theta‑burst transcranial magnetic stimulation. In last time new metaplasticity‑based protocols are being developed order increase effectiveness this technique. These consist several stimulation sessions day with an interval between sessions. However, there no experience such so far. Aim To assess safety and tolerability as well provide first evidence anti‑spastic effects original meta-plasticity‑based protocol patients sclerosis spasticity. Materials methods total, 5 (2 females 3 males, 28–53 y. o., disease duration – 11–18 years, EDSS 6.5–8.5 points) were included into study. separated by 1 hour applied daily, where single session consisted standard duration. Stimulation target was area cortical representation leg muscles, consequently both sides during days (15 total). Before after course effect (modified Ashworth scale) spasticity‑related pain, fatigue clinical global impression assessed. Results No serious adverse events Mild (sleepiness, pain at site) some cases, which did not affect patients’ willing continue participation After decrease legs registered 4 (to 12–39 % from basic level). Decrease (4 / 5) severity (3 also observed. Conclusion According experience, proposed safe, well‑tolerable potentially effective Therefore further investigation randomized controlled study seems justified.