Diagnostic and therapeutic issues of using transcranial magnetic stimulation in patients with writer’s cramp

Poydasheva A.G.; Semenova O.V.; Suponeva N.A.; Timerbaeva S.L.; Piradov M.A.

doi:https://doi.org/10.17116/jnevro201911910122

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Abstract:

Objective. To assess diagnostic and therapeutic values of transcranial magnetic stimulation (TMS) in patients with writer’s cramp (WC). Material and methods. Twelve right-handed patients with WC were enrolled in the study. All patients underwent low-frequency repetitive TMS (rTMS) over the premotor cortex of the hemisphere contralateral to the affected hand. The clinical efficacy was assessed using the Writer’s Cramp Rating Scale (WCRS) and the Medical Outcomes Study-Short Form (MOS-SF-36). Before and after the last rTMS session, motor mapping of abductor pollicis brevis muscle (APB) was performed using navigated TMS (nTMS). Localization, area, and amplitude-weighted area of the APB muscle cortical representations were compared with the healthy controls. The dynamics of the mentioned above parameters after the rTMS course was assessed. Results. Ten sessions of low-frequency rTMS over premotor cortex reduced the severity of WC clinical symptoms, with a duration of effect of at least 1 month (p<0.05). There was no significant difference between the area and the weighted area of cortical muscle representations between patients and healthy controls or in patients before and after rTMS. When assessing the localization of cortical muscle representations, two trends were noted: in 4 patients, the localization remained stable, with a shift in the center of gravity of less than 4 mm; in the other 8 patients, a shift in the center of gravity of more than 5 mm was noted. No significant correlations between the stability of the cortical muscle representations (the magnitude of the shift in the center of gravity) and the improvement on the WCRS scale were found. Conclusion. The low-frequency rTMS over the premotor cortex of the hemisphere contralateral to the affected hand can be used as an adjuvant therapy for WC. The TMS-motor mapping study did not show its diagnostic value.

Keywords:

writing cramp

repetitive transcranial magnetic stimulation

non-invasive brain stimulation

nTMS mapping

Authors:

Poydasheva A.G.

Research Center of Neurology, Moscow

Semenova O.V.

Vorokhobov City Clinical Hospital #67, Moscow, Russia

Suponeva N.A.

Nauchnyĭ tsentr nevrologii RAMN, Moskva

SPIN RSCI: 3223-6006
Scopus AuthorID: 35773598900
ResearcherID: B-4686-2012
ORCID: 0000-0003-3956-6362

Timerbaeva S.L.

Research Center of Neurology, Moscow, Russia

Piradov M.A.

Federal State budgetary scientific Institution «Research Centre of Neurology», Moscow

SPIN RSCI: 2860-1689
Scopus AuthorID: 7003731802
ResearcherID: B-4407-2012
ORCID: 0000-0002-6338-0392

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