Evaluation of Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation in the Gait of Patients with Multiple Sclerosis: A Systematic Review
Daniel De Siqueira Lima1, Bianca Etelvina Santos de Oliveira1, Yasmim Evelyn Lisboa Barbosa2, Jamille da Silva Abrantes2, José Felipe Lacerda Fernandes2, Maria Eduarda Donato Meneses Mendes2, Maria Eduarda Toscano dos Santos2, Tayane Ysla Medeiros Gomes2, Fernando de Paiva Melo Neto2, Ana Clara Araújo Medeiros 2, Thaís Magalhães Lima Leite2, Cláudio Renato Silva Lima2, Kaline Luna Castor Camelo2, Sandra Nagaumi Gurgel3, Artêmio José Araruna Dias 4
1CREM PB, 2UNIPÊ, 3FISIOMOD, 4UNIFACISA
Objective:
This study aimed to evaluate the effects of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) on the gait of patients with Multiple Sclerosis (MS).
Background:
TMS is a non-invasive neurophysiological technique that uses magnetic pulses, which act on the cerebral cortex, assisting neuromodulation. Furthermore, tDCS is also a non-invasive, safe and easy to apply technique, which is based on changes in the resting potential of the neuronal membrane. Both demonstrate results in terms of the patients' gait.
Design/Methods:
PubMed, LILACS and MedLine databases were used, with the descriptors “transcranial magnetic stimulation”, “transcranial direct current stimulation”, “multiple sclerosis” and “gait”. Longitudinal studies, such as case reports and clinical trials, that reported gait patterns before and after stimulation were included and literature reviews were excluded. There was no temporal cut due to the scarcity of the topic in the literature.
Results:
TMS significantly improves gait parameters. Regarding tDCS, physical exercise combined with stimulation appeared to enhance distances covered by patients. In a randomized clinical study with 17 participants divided into two groups, where the first group received tDCS plus physiotherapy and the second group received sham tDCS plus physiotherapy, the first group showed an average increase of 0,1 m/s in walking speed after 10 stimulation sessions. Furthermore, the experimental group achieved a reduction of 1,3 seconds in the TUG test. Regarding TMS, a case report in the literature demonstrated an increase of 0.25 m/s in a patient's walking speed after 9 stimulation sessions. In this study, a reduction of 3,4 seconds in the time to walk a distance of 6 meters was also observed.
Conclusions:
TMS and tDCS have brought improvements in the gait of patients with MS. However, randomized studies with broader samples are needed to compare these techniques accurately, minimizing bias and guiding therapeutic choices.