Cerebellar repetitive transcranial magnetic stimulation combined with physiotherapy for balance in people with multiple sclerosis: A randomized controlled trial with six-week follow-up

Background: Among neurological disorders, multiple sclerosis (MS) is the most commonly encountered in young
adults, causing significant disability particularly balance impairments. Various strategies like physiotherapy and
repetitive transcranial magnetic stimulation (rTMS) have been explored to improve balance in people with MS
(PwMS). This study aimed to evaluate the effects of cerebellar high-frequency rTMS combined with physiotherapy
on balance in PwMS.
Methods: Thirty ataxic participants with MS, including both sexes with relapsing-remitting or secondary progressive
MS, were randomly assigned to two groups. The study group (GI) received cerebellar high-frequency
rTMS with a tailored physiotherapy program for balance, while the control group (GII) received sham rTMS
and the same physiotherapy program. Treatment included three rTMS sessions and five physiotherapy sessions
per week, conducted concurrently over two weeks. Balance was assessed using the Overall Stability Index (OSI)
from Biodex Stability System (BSS) and Berg Balance Scale (BBS) at baseline, post-treatment, and at six-week
follow-up.
Results: Both groups demonstrated significant balance improvements post-treatment and at the six-week followup.
OSI scores improved at both time points (p < 0.05 for both groups). BBS scores also significantly increased
post-treatment and were maintained at follow-up (p < 0.05 for both). However, no significant differences were
observed between the two groups (p > 0.05).
Conclusion: Cerebellar rTMS combined with tailored physiotherapy positively affected balance in PwMS. However,
the absence of any significant differences between the sham and rTMS groups indicates that this rTMS
protocol does not provide a benefit beyond physiotherapy alone.