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Efficacy of Deep Transcranial Magnetic Stimulation (dTMS) In Long Standing Multiple Sclerosis (MS) Induced Gait Disorder: Case Report

Brain Stimulation, 5, 7, page e25

Background

dTMS utilizes H coils that have the capacity to reach 4cm below the skull and stimulate the lower limb. This has shown efficacy in improving function in patients who have suffered cerebral strokes. Conventional rTMS has been efficacious in treating MS induced fatigue and dexterity.

Objective

We report on 66-year-old-woman with gait disturbance, imbalance, bilateral lower extremity hyper-reflexia and right-sided proximal weakness from MS who had not improved in sixteen years.

Methods

Using the HMPCC coil over the motor strip, 18HZ, 90% resting motor threshold of the leg, 2second trains, 20second intervals, 55 trains, 1980 total pulses. Then the HMPCC was moved anteriorly 6cm over the medial prefrontal cortex, 18HZ, 100%MT, 2 second trains, 20 second intertrain intervals, 55 trains, 1980 total pulses.

Results

After ten treatments, she felt a significant improvement in her balance. She no longer had to think about her balance when she would stand up during the day or wake in the middle of the night to go to the bathroom. After twenty treatments, she stopped using a cane around the house and her right hamstring strength improved from a 3/5 to a 4/5, her quad remained at a 3. This was without any physical therapy or independent workouts.

Conclusions

This is the first report of dTMS treatment of an MS induced gait disorder.

Footnotes

a Advanced Mental Health Care Inc

b Ben Gurion University

Conflicts of interest: Dr. Tendler, Dr. Zangen and Dr. DeLuca have financial interest in Brainsway.