Therapeutic efficacy of transcranial magnetic stimulation for amyotrophic lateral sclerosis and spinocerebellar degeneration

Abstract We treated four patients with amyotrophic lateral sclerosis (ALS) and nine patients with spinocerebellar degeneration (SCD) using transcranial magnetic stimulation (TMS) with an SMN-1200 transcranial magnetic stimulator. The stimulus strength was below 1.5 T and the interpulse interval was greater than 5 s. The stimulus coil was placed on P3, P4 and the bilateral cervical and lumbar root in the ALS patients, and tangentially over Iz, 4 cm lateral to the right from Iz and 4 cm lateral to the left from Iz in the SCD patients. Ten consecutive pulses were delivered to each region in the ALS patients and 15 in the SCD patients. Transcranial magnetic stimulation (TMS) was applied for a total of 20 days for in-patients and once or twice a week as ongoing therapy for outpatients. Patients with ALS were assessed according to the Barthel index, and a respiratory function test was performed before and after TMS. Patients with SCD were neurologically assessed according to the International Cooperative Ataxia Rating Scale (ICARS). In addition, the patients were evaluated for regional cerebral blood flow (rCBF) by 99 m Tc-ECD SPECT using a modified Patlak-plot method before and after the TMS trial. No change in the Barthel index or rCBF was observed in patients with ALS. The respiratory function test results improved in one patient in the ALS group. The ICARS rating of seven patients with SCD improved after TMS. The rCBF of patients with SCD in the bilateral cerebellar hemispheres was significantly faster compared to their flow rate before TMS. These data suggest the potential usefulness of TMS as a therapeutic tool for ALS and SCD.