Adrenoleukodystrophy (ALD) is a rare genetic disease characterized by damage to the myelin sheath, the insulating protein coat that wraps around nerve cells. This myelin sheath is required for the proper conduction of electric impulses within nerve cells and its loss leads to neurological dysfunction.
Currently, there is no cure for ALD and only a handful of clinical trials are underway to find medical interventions to manage the debilitating symptoms of this disease.
Considered safe and non-invasive, repetitive transcranial magnetic stimulation (rTMS) is a neuromodulatory therapy that is normally used to treat anxiety and depression. It is also being investigated as a potential treatment for gait disturbances caused by ALD.
How rTMS works
rTMS is based on the principles of electromagnetic induction, which uses short electric pulses to stimulate specific areas in the brain. A device containing an electromagnetic coil is placed on the scalp of the patient. As an electric current is passed through this coil, the device generates magnetic pulses, which can travel through the skull and the soft tissue surrounding the brain and generate secondary electric pulses – stimulating the desired nerve cells. Based on where the device is placed, specific areas within the brain can be stimulated.
rTMS and ALD
A clinical trial (NCT03627416) evaluated the effect of rTMS in improving ALD-associated gait disturbances in 17 patients. During the trial, participants were given five daily sessions of 1,500 magnetic pulses of 10 hertz in frequency, which were administered to primary motor areas that control the movement of lower limbs. The trial primarily measured the time to walk 10 meters barefoot after an rTMS session. Dr. Jakub Antczak at the Jagiellonian University Medical College in Kraków, Poland, led the trial, and its results have not yet been published.
Past and current studies testing the potential of rTMS to reduce the severity of gait-induced disturbances caused by other conditions include Parkinson’s disease (five trials), vascular Parkinsonism (NCT03720691), partial spinal cord injury (three trials), and post-stroke paresis (NCT02892097).
The side effects of rTMS include lightheadedness, temporary hearing problems, mild headaches, and tingling in the face, jaw, or scalp.
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