Street T, Singleton C.
Five-Year Follow-up of a Longitudinal Cohort Study of the Effectiveness of Functional Electrical Stimulation for People with Multiple Sclerosis.
Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200121/
Few studies have examined the long-term consequences of using peroneal nerve functional electrical stimulation (FES) for people with multiple sclerosis (MS). This study examines orthotic effects on a longitudinal cohort and explores additional benefits of FES on self-reported measures such as joint pain.
One hundred forty-five people with foot drop and MS were included (mean age, 52 [range, 28-74] years). Orthotic effects, unassisted walking speed, and clinically important differences (ie, ≥0.05 and ≥0.10 m/s) were derived from walking speed over 10 m. Visual analogue scales examined joint pain, walking effort, trips, confidence, and quality of life. Measures were taken on day 1, after 6 months, and at 2, 3, 4, and 5 years.
A significant difference was found overall for walking with FES compared with walking without FES for the 5-year period (P < .001). Despite a significant decline in overall unassisted walking speed at baseline (0.58 m/s) compared with 5 years later (0.46 m/s) (P < .001), participants achieved an orthotic effect with (0.52 m/s) versus without (0.46 m/s) FES after 5 years (P < .001). A significant decrease in joint pain was found after 6 months compared with day 1 (P = .004), which was maintained after 5 years (P < .001).
Despite progression of MS, long-term users of FES still benefit from an orthotic effect after using FES for 5 years. The study highlights the need for further work to assess the perceived benefits of FES regarding the experience of joint pain.
Research Center of Neurology (RCN), Russian Federation, Moscow
High-frequency rTMS and iTBS for spasticity management in secondary-progressive multiple sclerosis.
The spasticity phenomenon is a significant factor in the development of disability. Repetitive transcranial magnetic stimulation (rTMS) is a promising treatment method for this disorder.
Our aim was to compare the effects of two protocols of rTMS - the high-frequency (HF) rTMS (20 Hz) and the intermittent theta-burst stimulation (iTBS) - on the level of spasticity and concomitant symptoms in patients with secondary progressive multiple sclerosis (SPMS) with an analysis of the duration of the effects up to 12 weeks after the stimulation course.
34 patients with SPMS and lower spastic paraparesis were randomized into 3 groups: 1) high-frequency (HF) rTMS (20 Hz); 2) intermittent theta-burst (iTBS) stimulation; 3) sham-stimulation. Spasticity and spasticity-assosiated symptoms were assessed by the Modified Ashworth Scale (MAS), the Subjective Evaluating Spasticity Scale (SESS) and the Numerical Analog Scale (NAS), Modified Fatigue Impact Scale (MFIS) and the pain level scale.
MAS was significantly reduced after the stimulation course in the HF-rTMS and iTBS groups. SESS was reduced post-intervention and at the two follow-ups in the iTBS group, while HF-rTMS produced a SESS reduction only at the 2-week follow-up, with no effects in the sham group. Conversely, reductions of pain and fatigue were found in the HF-rTMS group.
The results show that HF-rTMS and iTBS significantly reduce spasticity measured by MAS, in contrast to sham stimulation. Some evidence was found in favor of a longer-lasting effect of iTBS on SESS, and of a reduction in pain and fatigue after HF-rTMS. This article is protected by copyright. All rights reserved.