Transcranial magnetic stimulation as a resource associated with physiotherapy for rehabilitation of manual dexterity and gait in multiple sclerosis

Introduction: Transcranial Magnetic Stimulation (TMS) has benefits in the Multiple Sclerosis (MS) rehabilitation process when combined with therapeutic interventions. Objectives: To evaluate the influence of TMS combined with physiotherapy on the manual dexterity and gait of people with MS. Methods: Participated of this study 20 people with MS, 14 women and 6 men, aged 33 to 68 years (SD 50,0) and Kurtze Expanded Disability Status Scale (EDSS) between 0 and 6,5. The study was done at Brazilian Association of Multiple Sclerosis. The protocol consisted of 10 TMS sessions and 6 physiotherapy sessions with a protocol for lower limb strength training and static and dynamic balance. Participants were randomized and divided into 2 groups: Group I) with real stimulus, so that 10 received the TMS stimulus (primary motor cortex (Cz): 50 pulses per time, 30 trains, 20seconds of interval, totaling 1500 pulses at 90% of resting motor threshold and left dorsolateral prefrontal cortex (F3):10Hz, 50 pulses per train, 40 trains, 20 seconds interval, totaling 2000 pulses at 110% of resting threshold), and Group II) sham, that received the application without TMS stimulation (10 patients). All underwent physiotherapy. The Box and Block Test and Timed up and Go Test (TUG) was applied before the combined interventions and after 60 days. Results: It was found that 90% of participants showed improvement in manual dexterity, and 10% a plateau on Box and Block Test. At the Timed up and Go Test, it was found 70% of improvement and 30% of decrease in performance. Conclusion: This preliminary study suggests that TMS associated with physiotherapy has great potential in the rehabilitation of manual dexterity and gait on people with MS. The promising results encourage the acquisition of additional evidence.