Brain stimulation may be a promising treatment for spasticity in MS: a study But more work is needed to determine the best treatment approach

Non-invasive brain stimulation (NIBS) may offer promise for treating spasticity in multiple sclerosis (MS), but more work is needed to determine the best approach to use for patients, according to a new review study.

Studies under review have generally indicated that a type of brain stimulation called repetitive transcranial magnetic stimulation, or rTMS, can relieve spasticity — when muscles become abnormally tight, as often occurs in MS. However, evidence for another approach, known as transcranial direct current stimulation or tDCS, has been more limited.

“Seven studies using rTMS showed significant reductions in spasticity in people with multiple sclerosis after the intervention,” the researchers wrote, noting that “the remaining studies that provided tDCS did not show meaningful effects.”

The team said more clinical trials with long-term follow-up are needed to find the optimal approach.

the study, “Non-invasive brain stimulation for spasticity rehabilitation in multiple sclerosis: a systematic review of randomized controlled trials.published in the journal BM&R.

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The search for better therapies for spasticity in MS

Most people with multiple sclerosis suffer from muscle spasm, which is characterized by an abnormal tightness over time, which can lead to muscle stiffness and spasms that prevent movement. This difficult-to-treat MS symptom can aggravate other symptoms of the disease, such as pain, bladder problems, and sleep problems.

Anti-seizure medications are available, but their use is often associated with significant side effects. Thus, shifting focus toward other types of interventions, such as physical therapy or brain stimulation, may provide an alternative option for managing these symptoms.

Noninvasive brain stimulation, called NIBS for short, includes technologies such as rTMS and tDCS. In general, NIBS refers to interventions in which brain cells are stimulated by electrical currents that are delivered to the scalp. In the case of rTMS, a magnetic field is used to stimulate brain cells, while tDCS accomplishes this via low levels of direct electric current.

This stimulation is thought to help stimulate neuroplasticity, the process by which the brain regenerates in response to new input. This is believed to be beneficial for people with multiple sclerosis and other neurological diseases.

While a variety of studies have indicated that NIBS can safely benefit MS patients, its specific effects on spasticity require more research, according to the researchers.

As such, a team from Middle East University in Jordan conducted a systematic review of previous clinical trials that evaluated the effects of NIBS on spasticity-related outcomes in patients with multiple sclerosis.

A total of nine randomized studies were included, which cumulatively included 193 patients with MS. Overall, the majority (54.4%) of the participants were women, and the average age of the patients was 43.3 years. Most of them (73.4%) had a relapsing-remitting disease course.

Methods for NIBS included rTMS (seven studies) and tDCS (two studies), with the protocol and device used differing between studies.

Among the studies that included rTMS, four studies combined the NIBS approach with standard physical therapy, while three studies used brain stimulation alone. All seven studies found significant decreases in muscle strength in the lower extremities—particularly the legs, ankles, and feet—with the NIBS intervention.

In the two tDCS studies, no one found a significant change in lower limb muscle strength. The other saw physiological evidence of reduced muscle contraction, but the spasticity measure prescribed by the doctor was not altered.

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Exercise is seen as a key component in the treatment of MS-induced spasticity

Given the benefits of physical exercise in MS and in combination with rTMS—as well as its potential effects on neuroplasticity—the researchers believe that combining tDCS with physical rehabilitation interventions “may have superior effects in reducing spasticity in PwMS than using tDCS alone.”

“Therefore, future research should focus on examining the effects of combining NIBS with other physical therapy treatments to verify our hypothesis,” the researchers wrote.

Neither approach was associated with side effects in the included studies.

The scientists stressed that due to the small sample size and short follow-up times in a number of trials, the results should be interpreted with caution.

Furthermore, most of the selected studies focused primarily on understanding the effects of NIBS on cognitive function, and thus, the brain regions that were stimulated were not necessarily the best for targeting spasticity.

The team noted that more research is needed to understand the ideal NIBS parameters and stimulation protocols for controlling spasticity in MS, and whether these approaches are beneficial in the long term.

“The most effective treatment protocol for NIBS remains unclear,” the researchers wrote, noting that “more (randomized controlled trials) with long-term follow-up are encouraged.”

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