Abstract Details

Title Simultaneous rTMS and Piano Playing Improve Hand Dexterity and Cortical Motor Representation in a Professional Pianist with Multiple Sclerosis: A Case Report

Topic Clinical Neurophysiology

Presentation(s) IN11 - (-)

Poster/Presentation
Number 010

Objective

Background Motor learning is a fundamental process of neurorehabilitation. One of its neurophysiological substrates -modulation cortex excitability- provides the rationale for non invasive brain stimulation techniques, such as repetitive transcranial stimulation (rTMS). Therefore, association of neuromotor rehabilitation and rTMS may be more effective than their use alone.

Design/Methods A 39 y.o. pianist affected by multiple sclerosis with a bimanual (L>R) sensory-motor impairment due to 3 cervical relapses in the previous 3-12 months underwent a 3 week daily neurorehabilitation followed by sessions of H-coil rTMS (10 Hz, bilateral fronto-parietal cortex) simultaneous to piano exercises performed during time intervals between trains (11 sessions over the three week period). Before (T0) and at the end (T1) of the study, functional (NHPT, pinch, Jamar, MIDI sequencing) and neurophysiological tests (focal cortical mapping at 115% MT) were performed. NHPT and MIDI sequencing were also collected before and after each rTMS-piano session.

Results NHPT showed a progressive improvement in both hands, significant at T1 vs T0 (Right: 27.1'' vs 15.45'' ; Left 49.5'' vs 36.4'') as did piano performance. Cortical map motor representation decreased over both hemispheres (R>L).

Conclusions The improvement of hand dexterity and changes in cortical excitability can be interpreted through several mechanism. The proximity in time of rTMS and piano playing can lead to a reciprocal potentiation of networks related to motor learning and plasticity. The reduction and increased symmetry of cortical maps suggests a gain in cortical efficiency and interhemispheric rebalance. Rehabilitation sessions followed by simultaneous rTMS/hand motor training could improve motor performance and selectivity of cortical representation. Placebo-controlled studies are needed to quantify the hypothetical synergic effect of rTMS and motor training.

Authors/Disclosures
Arturo Nuara PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
Paolo Rossi	No disclosure on file
Mauro Comola	No disclosure on file
Emmanuelle Waubant, MD, PhD, FAAN (USCF MS Center)	The institution of Dr. Waubant has received research support from NIH. The institution of Dr. Waubant has received research support from NMSS. The institution of Dr. Waubant has received research support from PCORI. The institution of Dr. Waubant has received research support from Race to Erase MS. The institution of Dr. Waubant has received research support from Roche. The institution of Dr. Waubant has received research support from Department of Defense. Dr. Waubant has received publishing royalties from a publication relating to health care.
	No disclosure on file
Giancarlo Comi, MD (University Vita-Salute)	Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Janssen. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Aspen Healthcare. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Sanofi. Dr. Comi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Rewind.
Letizia M. Leocani, MD (University Vita-Salute San Raffaele, INSPE)	Dr. Leocani has received personal compensation in the range of $0-$499 for serving as a Consultant for Roche . Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bristol Myers Squibb. Dr. Leocani has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Med-ex learning.

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