SIN NAPOLI 2008

EFFECTIVENESS OF REPETITIVE MUSCLE VIBRATION IN SPASTIC

PARAPARESIS

F. Gragnani˝, L. De Armas˝, M.G. Piscaglia˝, N. Tenore˝, G. Albertini˝, S. Giaquinto˝, M. Galli', G. Antonini*, G.M. Filippi˚ ˝IRCCS San Raffaele Pisana, Roma; Dipartimento Bioingegneria, Politecnico di Milano'; *Clinica Neurologica, II Facoltà di Medicina, Università di Roma “La Sapienza”; ˚Istituto di Fisiologia Umana, Università Cattolica S.Cuore – Roma Objective: to analyze the efficacy of repetitive muscle vibration (rMV) to reduce spasticity in patients with spastic paraparesis. Material and Methods: 11 patients with spastic paraparesis, resistant to oral treatments for spasticity, were enrolled consecutively. They underwent to: clinical evaluation for spasticity according to the Ashworth scale; muscle strength evaluation by the Medical Research Council scale (MRC scale: 0-5); interview about frequency and severity of spasms and cramps; physical ability assessment by using the Barthel Index. In 7 patients the analysis of walking was also performed by Gait Analysis. All the subjects underwent to rMV treatment (100 Hz, < 20 µm amplitude), 90 minutes over 3 consecutive days. The rMV was focally applied on quadriceps femoris and gastrocnemius on both sides. Treatment effects were determined by comparing the scale scores and gait analysis data at the baseline (T0), at 7 days (T1) and at 30 days (T2) after rMV. Results: following rMV we observed a reduction of spasticity at the Ashworth scale in 9 patients (82%) at T1. In 6 subjects the improvement was still present after 30 days (T2). Muscle strength was improved in 4 patients (36%) and the effect was maintained at T2. All 6 subjects that complained of cramps or spasm improved, and showed a reduction of cramp and spasm score at T1, which was maintained at T2. In all 7 patients that underwent to Gait Analysis there were changes in the kinematical data and in 4 of them EMG data improved (electrical signals associated with muscle activation and deactivation of agonist and antagonist muscle). All the subjects improved in functional ability, evaluated with the Barthel Index (p < 0.001). Discussion: the main finding of this preliminary study is the possibility of inducing persistent improvements of some neurological symptoms by a repetitive and focal muscle vibration. Vibratory stimulation input seems able to induce plastic changes of excitability of selected population of neurons. This observation confirms a recent study showing Primary Motor Cortex excitability changes persisting up to 60 minutes after vibration ending. Conclusions: These preliminary data suggest the possibility that rMV may be a non-invasive and low expensive symptomatic aid in spasticity. A case-control study is warranted.