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.
ENT Team, EA4391, Faculty of Medicine, Paris Est Créteil University, Créteil, France
Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014-2018).
A group of European experts reappraised the guidelines on the therapeutic efficacy of repetitive transcranial magnetic stimulation (rTMS) previously published in 2014 [Lefaucheur et al., Clin Neurophysiol 2014;125:2150-206]. These updated recommendations take into account all rTMS publications, including data prior to 2014, as well as currently reviewed literature until the end of 2018. Level A evidence (definite efficacy) was reached for: high-frequency (HF) rTMS of the primary motor cortex (M1) contralateral to the painful side for neuropathic pain; HF-rTMS of the left dorsolateral prefrontal cortex (DLPFC) using a figure-of-8 or a H1-coil for depression; low-frequency (LF) rTMS of contralesional M1 for hand motor recovery in the post-acute stage of stroke. Level B evidence (probable efficacy) was reached for: HF-rTMS of the left M1 or DLPFC for improving quality of life or pain, respectively, in fibromyalgia; HF-rTMS of bilateral M1 regions or the left DLPFC for improving motor impairment or depression, respectively, in Parkinson's disease; HF-rTMS of ipsilesional M1 for promoting motor recovery at the post-acute stage of stroke; intermittent theta burst stimulation targeted to the leg motor cortex for lower limb spasticity in multiple sclerosis; HF-rTMS of the right DLPFC in posttraumatic stress disorder; LF-rTMS of the right inferior frontal gyrus in chronic post-stroke non-fluent aphasia; LF-rTMS of the right DLPFC in depression; and bihemispheric stimulation of the DLPFC combining right-sided LF-rTMS (or continuous theta burst stimulation) and left-sided HF-rTMS (or intermittent theta burst stimulation) in depression. Level A/B evidence is not reached concerning efficacy of rTMS in any other condition. The current recommendations are based on the differences reached in therapeutic efficacy of real vs. sham rTMS protocols, replicated in a sufficient number of independent studies. This does not mean that the benefit produced by rTMS inevitably reaches a level of clinical relevance.
Department of Rehabilitation, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Charles University in Prague, Czech Republic
Randomized Comparison of Functional Electric Stimulation in Posturally Corrected Position and Motor Program Activating Therapy: Treating Foot Drop in People With Multiple Sclerosis
Background: Functional Electric Stimulation (FES) is recommended for foot drop in multiple sclerosis, although little is known about its therapeutic effect.
Aim: To evaluate a therapeutic effect immediately and two months after program termination (persistent and delayed effect) of a new approach using FES in combination with correcting the patients' postural system. More specifically, we evaluate the effects of this approach on the patients' clinical functions and compared it with individual physiotherapy.
Design: Parallel randomised blind trial.
Setting: 2-month long treatments, Functional Electric Stimulation in Posturally Corrected Position (Group 1) and neuroproprioceptive facilitation and inhibition physiotherapy called Motor Program Activating Therapy (Group 2).
Population: 44 subjects with Multiple Sclerosis.
Methods: Primary outcomes: gait (the 2-Minute Walk Test; Timed 25-Foot Walk test; Multiple Sclerosis Walking Scale-12) and balance (by e.g. Berg Balance Scale, BBS; The Activities-Specific Balance Confidence Scale, ABC; Timed Up and Go Test, TUG). Secondary outcome: mobility, cognition, fatigue and subjects' perceptions (e. g. Multiple Sclerosis Impact Scale, MSIS; Euroqol-5 dimensions-5 levels, EQ-5D-5L).
Results: Group 1 showed immediate therapeutic effect in BBS (p = 0.008), ABC (p=0.04) and EQ-5D-5L (self-care, p=0.019, mobility p=0,005). The improvement in EQ-5D-5L persisted and in TUGcognitive we documented a delayed effect (p=0.005). Group 2 showed an immediate improvement in BBS (p = 0.025), MSIS (p=0.043) and several aspects of daily life (the effect on health today was significantly higher than in Group 1, significant difference between groups p=0.038).
Conclusions: FES in the Posturally Corrected Position has an immediate therapeutic effect on balance and patients' perceptions comparable to Motor Program Activating Therapy, and higher persistent and even delayed therapeutic effect.
Clinical rehabilitation impact: The study results point to the importance of correcting the patients' posture when applying FES, the possibility to treat foot drop by individual physiotherapy and the activation of the patients' auto reparative processes.
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