Repeated transcranial magnetic stimulation on the bilateral cerebellum to improve symptoms of ataxia with multiple system atrophy: a prospective, randomized, sham-controlled pilot study

Objectives: Ataxia is a common symptom in patients with Cerebellar subtype of Multiple system atrophy (MSA-C), but effective treatments remain elusive. The present study aims to investigate whether repetitive transcranial magnetic stimulation (rTMS) over the bilateral cerebellum could relieve ataxia in patients with MSA-C.

Patients and methods: This is a single-center, randomized and double-blind trial. 26 patients with MSA-C were randomly divided into experimental group and control group. The experimental group underwent (rTMS) in both cerebellum for 10 consecutive days, while the control group was given sham rTMS. The participants underwent clinical assessments at baseline (T0), and three follow-up timepoints, that is, immediately after the tenth treatment session (T1), 2 weeks (T2), and 4 weeks (T3) after T1. The Scale for the Assessment and Rating of Ataxia scores (SARA) was used as the primary outcome measure, with the Fatigue Severity Scale-9 (FSS-9), the Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Rating Scale-24 (HAMD-24) as secondary outcomes.

Results: Two-way repeated ANOVAs showed significant group × time interactions among SARA (p < 0.001), FSS-9 (p < 0.001), HAMA (p < 0.001) and HAMD-24 (p < 0.001). Post-hoc analyses showed that compared with T0, the activity group showed significant improvement in SARA, HAMA and HAMD-24 scores at T1, T2 and T3, and significant improvement in FSS-9 scores at T1 and T2, but no significant improvement in T3.

Conclusion: rTMS over bilateral cerebellum could provide short-term improvements for alleviating ataxia and the symptoms of fatigue, depression anxiety, but the beneficial effects last no more than 4 weeks.