High Frequency Suprathreshold rTMS to Cz Can Improve Gait Apraxia and Reduce Inflammatory Markers in Patients with Incidental Cerebral Small Vessel Disease
20 Pages Posted: 28 Jun 2022
Abstract
Background: Cerebral small vessel disease (cSVD) is a condition of clinical and neuroimaging presentations arising mainly from damage to the brain's small perforating vessels, leading to insidiously progressive disorders of gait, continence, and cognitive domains. Since repetitive transcranial magnetic stimulation (rTMS) showed efficacy in improving gait and cognition in subcortical pathologies, thus it might prove beneficial in cSVD.
Objective: To study the effect of high frequency rTMS on gait apraxia, cognitive and urinary symptoms in addition to Interleukin-1Beta (IL-1B) levels among patients with incidental cSVD.
Methods: 40 patients presenting with gait apraxia, cognitive and/or urinary symptoms with magnetic resonance imaging (MRI) documented cSVD, were randomized to active and sham groups of 20 patients each. Baseline demographic data, vascular risk factors, radiological scales were reported. Assessment of gait, balance, cognition, and urinary symptoms were done at baseline (T0), post-sessions (T1) and 1 month follow up (T2). IL-1B levels were assessed at T0 and T1. Active group received 6 daily sessions of 10 HZ rTMS to Cz, while sham group received 6 daily sessions with a sham coil.
Results: The active group showed significant improvement on all gait, balance, cognition, and urinary symptoms scales at T1 (p<0.001) that persisted till T2, and IL-1B level significantly decreased at T1 (p<0.001). Sham group did not show any significant improvement.
Conclusion: Six sessions of suprathreshold 10 HZ rTMS to Cz can improve gait apraxia, cognitive and sphincteric functions and can decrease IL-1B level in cases of incidental cSVD.
Note:
Funding Information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Neuromodulation research lab and its equipment in Ain Shams University, neurology department that was used in this study were established through a grant from Science & Technology Development Fund (STDF) in Egypt [project ID 2893, capacity building].
Conflict of Interests: The authors declare that there is no known competing financial interests or personal relationships that could influence the work reported in this paper.
Ethical Approval: The study was approved by the institutional ethics review board and all participants gave their written informed consent.
Trial Registration: Clinical trial (PACTR202106553331388).
Keywords: cerebral small vessel disease, transcranial magnetic stimulation, gait apraxia, cognitive, sphincter, inflammation
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