Abstract General Information


Outcome of non-invasive neuromodulation on the communication ability of people with multiple sclerosis


Introduction: The effect of multiple sclerosis (MS) on communications is considered an important factor of disability. Transcranial magnetic stimulation (TMS) is a treatment option. Objectives: To analyze the self-reported communicative ability of people with MS undergoing TMS. Methods: The protocol consisted of 10 interventions by TMS (primary motor cortex, left dorsolateral pre-frontal cortex) during 10 consecutive working days. The 6 items from domain 1 (cognition) of the self-administered disability assessment scale of the Brazilian version of World Health Organization-Disability Assessment Schedule 2.0 (WHODAS) was used before and after (30 days) TMS to identify patient’s opinion of ability to understand and communicate. Difficulty levels were rated on a 5-point Likert scale (0, none; 1, mild; 2, moderate; 3, severe; 4, extreme). Scores ranged from 0= minimum difficulty to 100= maximum. Results: The study comprised 30 people with MS: 22 (73%) women, 8 (27%) men, age 33-68 years (mean=50.0, SD=10.6), EDSS 0-6.5 (mean=4.6, SD=1.9), time diagnostic 1-24 years (mean=10.0, SD=7.2). All patients mentioned preserved ability for general understanding of the interlocutors’ speech. Prior to TMS, n=18/60% had moderate difficulty concentrating (including speech content/subject), moderate/severe to n=24/80% in recent memory, n10/33%) in problem solving, and n=10/33% in learning, fundamental mental and reasoning activities for communication, activity reported with a moderate degree of difficult in n=18/60% to start and maintain conversations due to inability to recall words (language disorder) or impairment in speech intelligibility (dysarthria). Self-reports pointed to a decrease in difficulties after TMS. Conclusion: We observed that WHODAS 2.0 is a favorable tool to identify the patient-reported outcome measures (PROMs) with MS about preserved abilities and cognitive impairments generated by disease, and to analyze the evolution of interventions. Non-invasive neuromodulation by TMS showed potential to improve verbal communication.


Multidisciplinary care


Alice Estevo Dias, Juliana Rhein Telles, Bruna Helena Sciarini, Demetrios Chiuratto Agourakis, Giovanna Paula Vidigal, Andre Santos Cetano, Carlos Mello Monteiro, Talita Dias Silva