Multiple sclerosis and related disorders · 2026
Short term effect of repetitive transcranial magnetic stimulation of the medial sensorimotor cortex for neurogenic pelvic floor dysfunction in multiple sclerosis: a randomized, double blind, sham controlled trial.
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Shehata Ghaydaa A, Ahmed Gellan K, Hassan Yosra Abdallah, Hasan Asmaa M
Аннотация
BACKGROUND: Neurogenic pelvic floor dysfunction, comprising bladder, bowel and sexual disturbance, affects most people with multiple sclerosis (MS) and responds poorly to pharmacotherapy. The medial sensorimotor cortex contains the pelvic floor representation, but controlled evidence for cortical neuromodulation in MS is scarce and bladder focused.
OBJECTIVE: To evaluate the short term efficacy and safety of inhibitory (1 Hz) repetitive transcranial magnetic stimulation (rTMS) over the vertex (Cz) in MS-related pelvic floor dysfunction.
METHODS: Forty-five patients with definite MS (Expanded Disability Status Scale (EDSS) ≤6.0) and actionable bladder symptoms Screening Tool (ABSST≥8) were randomized 2:1 in a double-blind, sham-controlled single centre trial to active (n = 30) or sham (n = 15) stimulation: 1 Hz rTMS at 90-100% resting motor threshold (900 pulses) over Cz across 10 weekday sessions; sham used a 90° tilted coil with synchronized scalp electrodes. ABSST, Neurogenic Bowel Dysfunction (NBD) score, Multiple Sclerosis Impact Scale 29(MSIS-29), Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ- 19), Overactive Bladder Questionnaire-Short Form (OAB -q SF) were assessed at baseline and 12 weeks post treatment.
RESULTS: ABSST fell from 18.6 ± 4.5 to 13.9 ± 5.1 with active stimulation versus 17.8 ± 3.8 to 17.1 ± 3.5 with sham (ANCOVA adjusted difference -3.98, 95%CI -6.75 to -1.22; standardized effect -0.93; p = 0.006). After baseline and multiplicity adjustment, benefit persisted for bowel (NBD; FDR adjusted p = 0.004) and sexual (MSISQ-19; p = 0.036) domains, but not OAB-q SF or MSIS-29. Bladder improvement correlated with bowel (r = 0.464) and sexual (r = 0.374) improvement. No serious adverse events occurred. All 45 participants completed all ten sessions and the 12 week assessment.
CONCLUSIONS: Inhibitory vertex rTMS produced sustained, coherent cross domain improvement in MS-related pelvic floor dysfunction exceeding sham, consistent with modulation of a shared central substrate and supports cortical neuromodulation as a promising, well tolerated adjunct.
OBJECTIVE: To evaluate the short term efficacy and safety of inhibitory (1 Hz) repetitive transcranial magnetic stimulation (rTMS) over the vertex (Cz) in MS-related pelvic floor dysfunction.
METHODS: Forty-five patients with definite MS (Expanded Disability Status Scale (EDSS) ≤6.0) and actionable bladder symptoms Screening Tool (ABSST≥8) were randomized 2:1 in a double-blind, sham-controlled single centre trial to active (n = 30) or sham (n = 15) stimulation: 1 Hz rTMS at 90-100% resting motor threshold (900 pulses) over Cz across 10 weekday sessions; sham used a 90° tilted coil with synchronized scalp electrodes. ABSST, Neurogenic Bowel Dysfunction (NBD) score, Multiple Sclerosis Impact Scale 29(MSIS-29), Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ- 19), Overactive Bladder Questionnaire-Short Form (OAB -q SF) were assessed at baseline and 12 weeks post treatment.
RESULTS: ABSST fell from 18.6 ± 4.5 to 13.9 ± 5.1 with active stimulation versus 17.8 ± 3.8 to 17.1 ± 3.5 with sham (ANCOVA adjusted difference -3.98, 95%CI -6.75 to -1.22; standardized effect -0.93; p = 0.006). After baseline and multiplicity adjustment, benefit persisted for bowel (NBD; FDR adjusted p = 0.004) and sexual (MSISQ-19; p = 0.036) domains, but not OAB-q SF or MSIS-29. Bladder improvement correlated with bowel (r = 0.464) and sexual (r = 0.374) improvement. No serious adverse events occurred. All 45 participants completed all ten sessions and the 12 week assessment.
CONCLUSIONS: Inhibitory vertex rTMS produced sustained, coherent cross domain improvement in MS-related pelvic floor dysfunction exceeding sham, consistent with modulation of a shared central substrate and supports cortical neuromodulation as a promising, well tolerated adjunct.