International Medical Case Reports Journal (May 2023)
Effects of Dry Needling on Spasticity in Multiple Sclerosis Evaluated Through the Rate-Dependent Depression of the H Reflex: A Case Report
Abstract
Felix León,1,* Leticia Manzo,1 Rebeca Kababie,1 Jimena Figueroa,1 Carlos Cuellar,2,* Pablo Herrero3,* 1Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México; 2School of Sport Sciences, Universidad Anáhuac México, Campus Norte, Huixquilucan, Estado de México, México; 3IIS Aragon, University of Zaragoza, Department of Physiatry and Nursing, Faculty of Health Sciences, Zaragoza, CP 50009, Spain*These authors contributed equally to this workCorrespondence: Carlos Cuellar, School of Sport Sciences, Universidad Anáhuac México, Av. Universidad Anáhuac 46, Lomas Anáhuac, Huixquilucan, Estado de México, CP 52786, México, Email [email protected]: Spasticity is a common symptom of multiple sclerosis (MS) which affects mobility. Dry Needling (DN) has shown a reduction in spasticity in neuromuscular conditions such as stroke and spinal cord injury although the mechanism of action is still unclear. In spastic individuals, the Rate-Dependent Depression (RDD) of the H reflex is decreased as compared to controls and analyzing the effects of DN in the RDD may help to understand its mechanism of action.Objective: To evaluate the effect of Dry Needling on spasticity measured by the Rate-dependent Depression (RDD) of the H reflex in an MS patient.Methods: Three time points were evaluated: Pre-intervention (T1), Post-intervention assessments were carried out in the seventh week at two-time points: Before DN (T2) and After DN (T3). Main outcomes included the RDD and latency of the H reflex in the lower limbs at stimulation frequencies of 0.1, 1, 2, and 5 Hz in a five consecutive pulses protocol.Results: An impairment of the RDD of the H reflex at frequencies ≥ 1 Hz was found. Statistically significant differences were found when comparing the mean RDD of the H reflex in Pre-intervention compared to Post-intervention at 1, 2, and 5 Hz stimulation frequencies. Mean latencies were statistically lower when comparing Pre- vs Post-intervention.Conclusion: Results suggest a partial reduction in spasticity represented by decrease of the excitability of the neural elements involved in the RDD of the H reflex following DN. The RDD of the H reflex could be implemented as an objective tool to monitor changes in spasticity in larger DN trials.Keywords: multiple sclerosis, dry needling, spasticity, H reflex, rate-dependent depression
