iTBS mode stimulation to cerebellar vermis improves balance function in patients with cerebellar-type multiple system atrophy: A case report and literature review

  Background   Repeated transcranial magnetic stimulation is increasingly used in patients with multiple system atrophy (MSA). Its stimulation parameters and stimulation mode are the focus of current research. There are few studies on the application of intermittent theta burst stimulation (iTBS) mode to improve the balance function for MSA patients.

  Objective   To explore the effect of iTBS stimulation on cerebellar vermis on balance function in patients with cerebellar-type MSA.

  Methods   The iTBS mode was used to stimulate the cerebellar vermis for patient. The stimulation intensity was 80% AMT, the internal frequency was 50 Hz, the internal number was 3, the interval frequency was 5 Hz, and the interval number was 10. The stimulation time was 2 seconds, with interval of 8 seconds, repetition number of 20 and single pulse number of 600, the total number of stimulations was 2 times with interval of 5 minutes, and the total number of pulses was 1 200, once a day for 10 times. The functional near-infrared spectroscopy system was used to detect and evaluate the brain function activity imaging of the patient, and the Berg Balance Scale, Fugl-Meyer Balance Assessment Scale and the Gait and Balance Training Assessment System were used to evaluate and analyze the patient's balance function before treatment, immediately after treatment, and on the tenth day.

  Results   The activation of oxygenated hemoglobin in the parietal lobe of the patient tended to be balanced on both sides, and the oxygenated hemoglobin content in the left premotor area and the left auxiliary motor area increased when performing the balance task after treatment. The score of Berg balance scale increased from 25 points before treatment to 39 points; The score of Fugl-Meyer balance function evaluation scale increased from 10 points before treatment to 11 points. Gait also improved in all aspects.

  Conclusion   iTBS mode stimulation of the cerebellar vermis can provide clinical evidence and reference idea for optimizing rehabilitation treatment to improve balance function for patients with cerebellar-type MSA.