Is there a therapeutic potential for repetitive Transcranial Magnetic Stimulation (rTMS) in the management of cognitive impairment in Multiple Sclerosis?
Multiple sclerosis (MS) is an autoimmune central nervous system disease, with inflammatory and degenerative components, affecting mostly young individuals, and resulting in accumulation of motor and cognitive dysfunction. Even from its insidious, subclinical phase, and through the entire course, cognitive impairment is frequently present, although often undiagnosed, and almost always untreated. Cognitive impairment is important, due to its impact on patients’ quality of life and everyday functioning capacacity as current pharmaceutical interventions have not provided sufficient therapeutic efficacy. One reason why cognitive impairment remains hidden for long periods is the brains functional reorganization, in other words its capacity to recruiting reserve networks in order to compensate for damaged ones, retaining “normal” functioning. In the era of neuromodulation, techniques such as repetitive Transcranial Magnetic Stimulation (rTMS) can serve as a non-pharmacological therapeutic option, enhancing neuroplasticity changes, and maintaining or improving cognitive functioning. In this short review we discuss the therapeutic potential of rTMS in the management of cognitive impairment in MS patients.