Case report details “promising” first use of bilateral cerebellar rTMS to treat post-stroke ataxia


In a new case report, researchers at University of California Los Angeles (UCLA) Health have described “promising results” using repetitive transcranial magnetic stimulation (rTMS) in the management of post-stroke cerebellar ataxia—a debilitating condition marked by impaired coordination and balance.

Ataxia can manifest as unsteady walking, difficulties with fine motor skills, and problems with speech, among other symptoms. Its severity can vary from mild to severe, and treatments often aim to manage symptoms and improve a person’s quality of life as therapeutic options are limited.

Writing in The Cerebellum, researchers led by Evan Hy Einstein (UCLA David Geffen School of Medicine, Los Angeles, USA) report the case of a 58-year-old male who had experienced a cerebellar haemorrhage approximately 12 years previously. Despite intensive rehabilitation, symptoms including slow and unsteady gait, balance issues and urinary incontinence persisted in the long term.

As such, researchers detail, the patient sought consultation for potential rTMS treatment. His primary complaints focused on his slow and unsteady gait along with challenges related to balance and stability. The decision was made to employ bilateral cerebellar rTMS, representing an “innovative approach” to address the condition, Einstein et al report.

Across five daily sessions, the patient underwent rTMS targeting both the right and left cerebellar hemispheres. He reported subjective improvement after just two days of stimulation and, by the fifth day, there were noticeable improvements—the patient’s walking speed increased from 0.57m/s to 0.6m/s, and his balance improved, rising from 27 to 38 on the Berg balance scale.

More significantly, the researchers further note, the patient was able to rise from sitting unaided and was able to bend to pick up a pencil from the floor easily. He reported improved balance and stability in that he could stand unaided, and without using hand supports, while performing activities of daily living in the bathroom like showering and shaving, which he was unable to do prior to treatment.

“This case represents the first instance of bilateral cerebellar rTMS used to treat post-stroke cerebellar ataxia,” said Einstein. “Further research is warranted to ascertain long-term clinical benefits and explore the underlying neural mechanisms of this innovative treatment, but it underscores the potential of tailored treatment protocols that consider the specific aetiology of ataxia.”


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