Intermittent theta burst stimulation improves spasticity, pain and cognitive functions in progressive multiple sclerosis: a pilot study

INTRODUCTION: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system marked by inflammation and demyelination. Neurofilament light chain (NfL) serves as a biomarker for neurodegeneration. Non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) may alleviate MS-related symptoms. OBJECTIVE: To assess the effects of intermittent theta burst stimulation (i-TBS), a TMS protocol, on spasticity, disability, quality of life, fatigue, cognition, and serum NfL levels in patients with progressive MS. METHODS: Thirty-six patients with primary or secondary progressive MS were randomized to either i-TBS (10 sessions over 2 weeks) or control (no stimulation). Outcomes included EDSS, MAS, VAS, walking speed, MSQOL-54, fatigue, cognition, and serum NfL. Assessments were conducted at baseline and 3 months (both groups), and also at 1 month in the i-TBS group. RESULTS: i-TBS significantly improved spasticity (p = 0.002), pain (p = 0.002), walking speed (p = 0.001), and daily activities (p = 0.005). Improvements were also observed in verbal learning (p = 0.020) and visuospatial memory (p = 0.006). No significant change in serum NfL levels was detected. CONCLUSION: Although i-TBS did not alter serum NfL levels, it was associated with symptom relief and cognitive gains in progressive MS. These preliminary results support the potential of i-TBS as a supportive neurorehabilitation strategy.