Back Ground: Cerebral small vessel disease (CSVD) is a condition of clinical and neuroimaging presentations that arise mainly from damage to the brain's small perforating vessels causing lacunar type strokes, Intracranial hemorrhage and insidious significant deficits in gait, urinary and cognitive domains which are progressive in nature rTMS showed efficacy regarding improving gait and cognition in subcortical pathologies as Multiple Sclerosis, Parkinson disease and vascular dementia. rTMS exerts efficacy through enhancing neuroplasticity and in part modulating associated neuronal inflammation. Aim of work: Study the effect of High frequency rTMS on Cognitive symptoms among patients with cerebral small vessel disease with no acute stroke presentation. Patients and Methods: 40 patients are included, with MRI
documented small vessel disease, symptomatic by either gait or cognitive or urinary symptoms or all. Randomized to 20 active and 20 sham groups, Active group received 6 sessions of high frequency Cz of intensity of 110% Motor Threshold. Sham group received 6 Sham sessions. Baseline line demographic data, vascular risk factors, radiological scales (Fazekas and Global cortical atrophy scale) were done to all patients, Baseline, post-sessions and 1 month follow up assesments were done regarding cognitive scales including FAB ( Frontal assessment Battery) and Adam Brook scale.
Results: Comparing active group to sham group. Active rTMS has statistically significant improved FAB scores (P < 0.001) and Adam Brook scale scores (P < 0.001) Conclusion: our results suggested that High frequency Cz applied rTMS sessions showed statistically significant improvement in cognitive performance in patients with small vessel disease.