Ab0154 Influence of Repetitive Transcranial Magnetic Stimulation of the CNS on Gait Parameters in Fibromyalgia Patients: A Randomised, Double-Blind, Placebo-Controlled Study (Interim Analysis)

Background: Individuals with fibromyalgia (FM) often experience diminished performance in their activities of daily living, potentially attributed to a decline in physical capacities. They exhibit changes in their walking patterns, characterised by alterations in stride length, walking speed, and overall gait dynamics. These gait alterations not only contribute to the physical challenges faced by FM patients but may also contribute to an increased risk of falls and a decrease in overall mobility, thus leading to a shift towards a more sedentary lifestyle. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive therapeutic approach that employs a magnetic field to stimulate various brain structures. While rTMS has been explored for its potential to enhance gait and balance in various neurological conditions, there is currently no available data on its effectiveness in improving these aspects in FM. Objectives: The study aimed to evaluate the impact of rTMS on the gait in individuals with primary FM when engaged in challenging motor and/or cognitive tasks. Methods: Twenty-nine patients (27 F, 2 M) were randomised to rTMS (n = 14) or sham treatment (n = 15) after successfully fulfilling the enrollment criteria. rTMS was applied to the left dorsolateral prefrontal cortex (DLPFC) for 10 days at a frequency of 10 Hz and an intensity of 130% of the specified motor threshold. One session of rTMS consisted of 5 seconds of stimulation (at a frequency of 10 Hz, for a total of 50 stimuli) and a 10-second pause. Patients received 2000 stimuli per day (50 stimuli in 40 repeated sessions). The placebo was applied with an inactive "sham" coil, which resembles active treatment. The GAITRite walkway system was used to assess quantitative spatial (stride length: SL) and temporal (cycle time: CT, swing time: ST, and double support time: DST) gait parameters across four conditions: baseline gait, with motor (walking with a glass of water), mental (serial substraction from number 100), or combined task. These conditions resemble everyday activities of daily living. Results: At the baseline, there were no differences between the groups across all four conditions in any of the parameters. Notably, individuals in the placebo group exhibited a significant increase in cycle time during the mental task (Table 1.) while having a significant reduction in stride length in the context of the combined task (Table 2). No significant distinctions between the groups were observed in delta values before and after treatment concerning the remaining investigated characteristics (p > 0.05). Both groups reported experiencing mild headaches as an adverse event, and these symptoms persisted for no more than two days without any treatment (p > 0.05). Conclusion: Repetitive transcranial magnetic stimulation (TMS) holds promise as a non-invasive treatment for rehabilitating individuals with fibromyalgia, potentially stopping future deterioration of gait, especially while performing demanding mental and/or motor tasks. To test our hypothesis that the observed changes in certain gait parameters are indirect, future studies are warranted, including a longer period of follow-up. These investigations should explore the possibility that TMS exerts an influence on other fibromyalgia symptoms, including pain, mood, and fatigue, ultimately contributing to the preservation of gait control in FM patients and fall prevention. Table 1. Table 2. REFERENCES: NIL. Acknowledgements: Many thanks go to my colleagues from Institute of Rheumatology, Belgrade, Serbia. Disclosure of Interests: None declared.