Dados do Trabalho

Título

Fatigue, balance and gait of people with multiple sclerosis after treatment with transcranial magnetic stimulation associated with physical therapy: a pilot study

Resumo

Background: Multiple Sclerosis (MS) is a demyelinating autoimmune disease that causes CNS damage and disabling symptoms. Transcranial Magnetic Stimulation (TMS) has benefits in the rehabilitation process when combined with therapeutic interventions. Objective: To evaluate the influence of TMS combined with physiotherapy on the balance, gait and fatigue of people with MS. Methods: Participated of this study 20 people with MS, 14 women and 6 men, aged 33 to 68 years (SD 50,0) and Kurtze Expanded Disability Status Scale (EDSS) between 0 and 6,5. The study was done at Brazilian Association of Multiple Sclerosis. The protocol consisted of 10 TMS sessions and 6 physiotherapy sessions with a protocol for lower limb strength training and static and dynamic balance. Participants were randomized and divided into 2 groups: Group I) with real stimulus, so that 10 received the TMS stimulus (primary motor cortex (Cz): 50 pulses per time, 30 trains, 20seconds of interval, totaling 1500 pulses at 90% of resting motor threshold and left dorsolateral prefrontal cortex (F3):10Hz, 50 pulses per train, 40 trains, 20 seconds interval, totaling 2000 pulses at 110% of resting threshold), and Group II) sham, that received the application without TMS stimulation (10 patients). All underwent physiotherapy. The Berg Balance Scale, Timed up and Go Test (TUG) and Modified Fatigue Impact Scale (MFIS) was applied before the combined interventions and after 60 days. Results: It was found that 70% of participants showed improvement in balance, 20% a decrease and 10% a plateau on Berg Balance Scale. At the Timed up and Go Test, it was found 70% of improvement and 30% of decrease in performance. At the fatigue evaluation with Modified Fatigue Impact Scale, in Cognitive domain, it was found 90% decrease in fatigue values and 10% increase. In the physical domain, it was analyzed that 65% had an improvement in the indexes, 25% a worsening and 10% remained the same. In the psychosocial domain, 70% showed a decrease in fatigue levels, 20% an increase and 10% remained unchanged. Conclusion: This preliminary study suggests that TMS associated with physiotherapy has great potential in the rehabilitation of balance, gait and fatigue on people with MS. The promising results encourage the acquisition of additional evidence.

Palavras Chave

Multiple sclerosis; Physical Therapy, Transcranial Magnetic Stimulation.