Multiple Sclerosis (MS) is a chronic, inflammatory and autoimmune disease of the Central Nervous System (CNS). It is the main cause of neurological disability in young adults in western countries.

Besides the classical neurological symptoms, depression and fatigue are the most frequent symptoms affecting 90% of patients at the beginning or during the course of the disease.

Nor are there too many controlled pharmacological trials which would offer therapeutic solutions for fatigue and depression, although considerable progress has been made in its management.

In the field of Neurosciences, Neuromodulation modifies and harmonizes nerve activity by supplying pharmaceutical, electrical and mechanical agents or directly modulating a target area. It relies on technological tools that act specifically on neural structures.

Neuromodulation therapy should be considered for selected patients though a multidisciplinary evaluation, either as a complement to other types treatment, or as an alternative when symptoms do not respond adequately to conservative measures, for instance, when existing drugs are ineffective or become a problem due to the development of tolerance, addiction, adverse side effects or toxicity.

Neuromodulation therapies continue to undergo ongoing research that elucidates its effects and improves its applications.

The stimulation coils, H-Coil, embedded in a helmet, and developed according to the three-dimensional cytoarchitecture of the brain allow to stimulate subcortical circuits and nodes, not only transcortical nodes and synapses as with superficial magnetic stimulation.

TMS has been frequently used to investigate the altered hemispheric and interhemisphreic connectivity of MS. Recently, therapeutic trials have been developed to treat specific symptoms related to MS by deep repetitive TMS. H-10 Coil, from BrainsWay, with an energy penetration capacity around 6cm deep, successfully stimulates deep prefrontal regions of the brain, demonstrating safety and good tolerance in healthy volunteers and in patients suffering from major depression. These regions of the brain play an important role in affective disorders. Based on these principles, and applying dTMS to patients with MS, it has been proved to be effective in patients between 18 and 60 years suffering from fatigue or depression.

Eleven years of contact and use of superficial-TMS guarantee the best use of dTMS.

To administer the treatment, a prior assessment is required as well as to fulfill with the criteria of the protocol recommended by BrainsWay commercial house.

Deep TMS is a non-invasive technique, with no side effects which is administered on an outpatient basis nor does it need anesthesia. It does not disrupt daily activity or limit personal autonomy. The duration of the session is 20 min.

Treatments are administered following the advice of the commercial house, resulting in individualized treatments through the calculation of the Motor Threshold in rest.

Deep repetitive Transcranial Magnetic Stimulation applied to MS has been approved (October 2014) by the EMA, and it does not interfere with pharmacological, nutritional treatment, or rehabilitation process that the patients are receiving.