Unlocking Therapeutic Potential: The Role of Theta Burst Stimulation in Multiple Sclerosis Management

Lo, D. F.; Palhang, M.; Gawash, A.; Zia, H.; Goodwin, B. J.; Patel, K.; White, C. P.

Abstract:

Current therapies for multiple sclerosis (MS) often have limited efficacy and side effects, necessitating alternative approaches. Noninvasive brain stimulation (NIBS), such as transcranial direct current stimulation and transcranial magnetic stimulation (TMS), offers potential solutions. Among NIBS techniques, theta burst stimulation (TBS) is notable for its ability to modulate cortical activity. The objective of this systematic review is to assess the impact of TBS on MS symptoms. The study conducted rigorous systematic searches in PubMed, Google Scholar, and Scopus databases up to June 2023, using specific Medical Subject Headings terms related to NIBS and MS, such as TMS and TBS, in conjunction with terms like MS or demyelinating disease. Additionally, the bibliographic references of included studies, book chapters, and original articles were manually reviewed. The study selection process involved a 2-tiered screening mechanism, beginning with an evaluation of titles and abstracts, followed by a full-text review of selected articles. Inclusion criteria incorporated randomized controlled trials (RCTs) focusing on TBS with MS patients. Exclusion criteria included non-qualitative, non-MS, and non-TBS studies. Risk of bias assessment was conducted using the 2008 Cochrane Risk of Bias 2 Scale for RCTs. Data extraction was conducted by thoroughly reviewing each research article and systematically recording the relevant information using a standardized data extraction form, ensuring consistency and accuracy throughout the process. In a systematic review encompassing 5 randomized controlled trials involving 117 individuals with relapsing-remitting or secondary progressive MS across Italy, France, and Russia, various forms of TBS were applied. These interventions ranged from intermittent TBS (iTBS) to continuous intermittent TBS (c-iTBS) that demonstrated favorable outcomes. Notably, TBS interventions led to significant reductions in spasticity, fatigue, and pain, with c-iTBS combined with vestibular rehabilitation showing additional improvements in vestibular-ocular reflexes, gait, and balance. While specific protocols varied among the studies, collectively, the results suggest promise for TBS approaches in alleviating MS-related symptoms. The findings of this review suggest that TBS may hold promise in addressing specific MS symptoms, notably fatigue and spasticity. Future research should include a more diverse participant pool to explore TBS effects across different MS subtypes and aim for larger sample sizes to enhance statistical power and result reliability.

Patologie/Applicazioni:

• Theta Burst
• Plasticità cerebrale

Anno:

2024

Tipo di pubblicazione:

Articolo

Parola chiave:

sclerosi multipla; Theta Burst; stimolazione magnetica transcranica

Testata scientifica:

Psychiatrist

Mese:

04

Nota:

In questa revisione sistematica - comprendente 5 studi randomizzati e controllati, che hanno coinvolto 117 individui con Sclerosi Multipla recidivante-remittente o secondariamente progressiva -viene valutato l'impatto di protocolli di Theta Burst Stimulation (TBS) sui sintomi della sclerosi multipla (SM). Tali trattamenti hanno dimostrato risultati favorevoli. Emerge, infatti, che i pazienti con SM sottoposti a protocolli TBS, raggiungono una riduzione significativa in particolare dell'affaticamento, della spasticità musclolare e del dolore, ampliando il campo di applicazione della stimolazione trasncranica magnetica (TMS).

DOI:

10.4088/PCC.23r03645