2025 American Academy of Neurology Abstract Website

David Abraham¹, Rebeca Silva², Daniel De Siqueira Lima³, Frederico De Sousa Marinho Mendes Filho⁴, João Victor de Oliveira Ramos², João Pedrosa², Helvécio Filho⁵, Saul Dominici⁶, Elizabeth de Farias⁷, Milene Capitanio⁸, Arthur Corvelo⁹, Murilo Geremias¹⁰, Christian Fukunaga¹¹, Yasmin Lima¹², Richard Reis¹³, BIANCA OLIVEIRA¹⁴
¹Federal University of Amazonas, ²Federal University of Paraíba, Brazil, ³University of California, San Diego, ⁴Federal University of Amazonas, Brazil, ⁵University of Fortaleza, Brazil, ⁶Federal University of Maranhão, São Luis, Brazil, ⁷Federal University of Roraima, Brazil, ⁸Community University of Chapecó Region, Brazil, ⁹Faculty of medicine, University of Grande Rio, Brazil, ¹⁰University of Joinville Region, Brazil, ¹¹Centro Universitário FMABC, Brazil, ¹²Faculty Pernambucana of Health, Brazil, ¹³University of Itaúna, Brazil, ¹⁴Horizon TherapeuticsParaíba Multiple Sclerosis Reference Center, Brazil

Objective:

To evaluate the efficacy of Transcranial Magnetic Stimulation (TMS) in gait of patients with Multiple Sclerosis (MS).

Background:

MS is a neurological disorder characterized by demyelination in the central nervous system, leading to increased muscle tone and motor dysfunction. TMS, a noninvasive technique, is used to stimulate nerve cells and activate specific regions of the brain. Multiple studies suggest TMS may improve motor symptoms, but the evidence quality is low and often insufficient to confirm its benefit.

Design/Methods:

A systematic search was performed across PubMed, Embase, Web of Science, and Cochrane databases up to September 2024. Studies evaluating the safety and efficacy of TMS on gait were included. The primary outcomes assessed were the Timed Up and Go (TUG) test, the Modified Ashworth Scale (MAS), and the Fatigue Scale.

Results:

Of the 919 studies screened, seven met the inclusion criteria, including 73 patients with a mean age of 45.7 years. In the evaluation of the Fatigue, being mainly made by the Modified Fatigue Impact Scale (MFIS), has found repetitive TMS as a valid choice to significantly reduce the mean ± SD for this outcome. (Variation post intervention: 3.95± 1.40 a 21.07 ± 10.06). Two measures were used to access balance and gait: the Timed Up and Go (TUG) and Berg Balance Scale (BBS). Across the included studies, the TMS group consistently showed significant improvements in both TUG and BBS scores, indicating enhanced balance and gait capabilities. The Modified Ashworth Scale (MAS) was employed to evaluate spasticity. While a trend towards TMS, were a higher reduction has been seen in some studies, carried out by the comparison with a sham group.

Conclusions:

This review suggests that TMS may improve gait, balance, and alleviate fatigue in patients with MS. Further large, well-designed trials are needed to confirm these findings and optimize TMS protocols for MS.