Iodice Rosa, Manganelli Fiore, Dubbioso Raffaele
Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Italy.
Restor Neurol Neurosci. 2017;35(5):497-509. doi: 10.3233/RNN-170735.
Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and a leading cause of disability in young adults. Many disabling symptoms in MS, such as spasticity, pain, depression and cognitive deficits are not fully controlled by drug treatment. Non-invasive brain stimulation (NIBS) techniques can be used as tools for modulating altered cortical excitability and plasticity MS patients, providing an improvement in disabling symptoms affecting such patients.
This review reported and summarized some of the most interesting and promising recent achievements regarding the therapeutic use of NIBS in MS patients.
We reviewed the clinical application of transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), emphasizing their effect on clinical symptoms and signs that are commonly involved in MS patients. In addition, we shortly described new NIBS protocols, such as transcranial alternating current stimulation and transcranial focused ultrasound stimulation as potential and innovative therapeutic options to be applied in future studies in MS patients.
We reviewed twenty-one studies covering six main clinical domains. Most of such studies focused on fatigues (33.3%), motor performance (19%) and spasticity (19%), sparse results were about pain (9.5%), cognitive abilities (9.5%), sensory deficit (4.8%) and bladder function (4.8%). The most promising results have been published for the improvement of motor (i.e. hand dexterity) and cognitive performances (i.e. attention and working memory) by applying rTMS or tDCS alone or in association with motor/cognitive training, for pain's treatment by using tDCS.
There are still no official recommendations for the therapeutic use of tDCS or rTMS in MS. The huge inter-individual variability of NIBS efficacy is still a big challenge which needs to be solved. However, well-designed studies, deeper knowledge about pathomechanisms underlying MS, and the combination of such techniques with motor and cognitive rehabilitation might results in higher effectiveness of NIBS.
多发性硬化症（MS）是一种中枢神经系统的炎性脱髓鞘疾病，是年轻成年人致残的主要原因。MS中的许多致残症状，如痉挛、疼痛、抑郁和认知缺陷，药物治疗并不能完全控制。非侵入性脑刺激（NIBS）技术可作为调节MS患者皮质兴奋性和可塑性改变的工具，改善影响此类患者的致残症状。
本综述报告并总结了近期关于NIBS在MS患者治疗应用方面一些最有趣且有前景的成果。
我们回顾了经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS）的临床应用，重点关注它们对MS患者常见临床症状和体征的影响。此外，我们简要描述了新的NIBS方案，如经颅交流电刺激和经颅聚焦超声刺激，作为未来应用于MS患者研究的潜在创新治疗选择。
我们回顾了涵盖六个主要临床领域的21项研究。此类研究大多聚焦于疲劳（33.3%）、运动表现（19%）和痉挛（19%），关于疼痛（9.5%）、认知能力（9.5%）、感觉缺陷（4.8%）和膀胱功能（4.8%）的结果较少。通过单独应用rTMS或tDCS或与运动/认知训练联合应用来改善运动（即手部灵活性）和认知表现（即注意力和工作记忆），以及使用tDCS治疗疼痛方面，已发表了最有前景的结果。
对于tDCS或rTMS在MS治疗中的应用，目前仍没有官方推荐。NIBS疗效的个体间巨大差异仍是一个需要解决的重大挑战。然而，精心设计的研究、对MS潜在发病机制的更深入了解，以及将此类技术与运动和认知康复相结合，可能会提高NIBS的有效性。
