Repetitive transcranial magnetic stimulation of the motor cortex ameliorates spasticity in multiple sclerosis

Objective: To investigate whether repetitive transcranial magnetic stimulation (rTMS) can modify spasticity. Methods: We used high-frequency (5 Hz) and low-frequency (1 Hz) rTMS protocols in 19 remitting patients with relapsing remitting multiple sclerosis and lower limb spasticity. Results: A single session of 1 Hz rTMS over the leg primary motor cortex increased H/M amplitude ratio of the soleus H reflex, a reliable neurophysiologic measure of stretch reflex. Five hertz rTMS decreased H/M amplitude ratio of the soleus H reflex and increased corticospinal excitability. Single sessions did not induce any effect on spasticity. A significant improvement of lower limb spasticity was observed when rTMS applications were repeated during a 2-week period. Clinical improvement was long-lasting (at least 7 days after the end of treatment) when the patients underwent 5 Hz rTMS treatment during a 2-week protocol. No effect was obtained after a 2-week sham stimulation. Conclusions: Repetitive transcranial magnetic stimulation may improve spasticity in multiple sclerosis.