Şan Ayça Uran, Yılmaz Bilge, Kesikburun Serdar
Department of Physical Rehabilitation Medicine, Karabuk University Karabuk Training and Research Hospital, Karabuk, Turkey.
Department of Physical Rehabilitation Medicine, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey.
J Clin Neurol. 2019 Oct;15(4):461-467. doi: 10.3988/jcn.2019.15.4.461.
This randomized controlled study examined the effect of repetitive transcranial magnetic stimulation (rTMS) on spasticity in patients with multiple sclerosis (MS).
This study included 16 patients with a history of MS and spasticity in the adductor hip muscles according to the Modified Ashworth Scale (MAS). The participants were randomized into the active group (=10) and control group (=6), in which active rTMS and sham rTMS were applied in 10 sessions, respectively. A physical therapy and rehabilitation program was applied along with rTMS sessions in both groups. The evaluation parameters were assessed at baseline and then 1 week and 1 month after applying rTMS.
Statistical analyses with post-hoc correction revealed statistically significant improvements in the active group compared to the control group in the bilateral MAS score, Penn Spasm Frequency Scale score, patient satisfaction, amount of urine leakage, actual health status, perceived health status, energy and fatigue, role limitations due to physical problems, social function, overall quality of life, cognitive functioning, physical health composite score, mental health composite score, and total score on the Multiple Sclerosis Quality of Life-54 (MSQOL-54) (<0.05). Statistically significant changes were detected in the MSQOL-54 social function and physical health composite scores of patients in the control group (<0.05).
Active rTMS combined with a physical therapy program reduced spasticity in MS patients compared to the control group that received only physical therapy. Further comprehensive and more advanced studies are needed to confirm the present findings.
本随机对照研究探讨了重复经颅磁刺激（rTMS）对多发性硬化症（MS）患者痉挛状态的影响。
本研究纳入了16例有MS病史且根据改良Ashworth量表（MAS）评定内收髋肌存在痉挛的患者。参与者被随机分为治疗组（n = 10）和对照组（n = 6），分别接受10次的主动rTMS和假rTMS治疗。两组在进行rTMS治疗的同时均实施物理治疗与康复计划。评估参数在基线时进行评定，随后在rTMS治疗后1周和1个月时再次评定。
经事后校正的统计分析显示，与对照组相比，治疗组在双侧MAS评分、宾夕法尼亚痉挛频率量表评分、患者满意度、尿失禁量、实际健康状况、感知健康状况、精力与疲劳、因身体问题导致的角色限制、社会功能、总体生活质量、认知功能、身体健康综合评分、心理健康综合评分以及多发性硬化症生活质量-54（MSQOL-54）总分方面均有统计学意义的改善（P < 0.05）。对照组患者的MSQOL-54社会功能和身体健康综合评分也有统计学意义的变化（P < 0.05）。
与仅接受物理治疗的对照组相比，主动rTMS联合物理治疗计划可减轻MS患者的痉挛状态。需要进一步开展更全面、更深入的研究来证实本研究结果。
