Cerebellar repetitive transcranial magnetic stimulation combined with physiotherapy for balance in people with multiple sclerosis: A randomized controlled trial with six-week follow-up.

BACKGROUND

Among neurological disorders, multiple sclerosis (MS) is the most commonly encountered in young adults, causing significant disability particularly balance impairments. Various strategies like physiotherapy and repetitive transcranial magnetic stimulation (rTMS) have been explored to improve balance in people with MS (PwMS). This study aimed to evaluate the effects of cerebellar high-frequency rTMS combined with physiotherapy on balance in PwMS.

METHODS

Thirty ataxic participants with MS, including both sexes with relapsing-remitting or secondary progressive MS, were randomly assigned to two groups. The study group (GI) received cerebellar high-frequency rTMS with a tailored physiotherapy program for balance, while the control group (GII) received sham rTMS and the same physiotherapy program. Treatment included three rTMS sessions and five physiotherapy sessions per week, conducted concurrently over two weeks. Balance was assessed using the Overall Stability Index (OSI) from Biodex Stability System (BSS) and Berg Balance Scale (BBS) at baseline, post-treatment, and at six-week follow-up.

RESULTS

Both groups demonstrated significant balance improvements post-treatment and at the six-week follow-up. OSI scores improved at both time points (p < 0.05 for both groups). BBS scores also significantly increased post-treatment and were maintained at follow-up (p < 0.05 for both). However, no significant differences were observed between the two groups (p > 0.05).

CONCLUSION

Cerebellar rTMS combined with tailored physiotherapy positively affected balance in PwMS. However, the absence of any significant differences between the sham and rTMS groups indicates that this rTMS protocol does not provide a benefit beyond physiotherapy alone.

TRIAL REGISTRATION: NCT06265922 on ClinicalTrials.gov.