Purpose: Freezing of gait (FOG) affects mobility and balance seriously. Few reports have investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on FOG in Parkinson’s disease (PD). We investigated the efficacy of high-frequency rTMS for the treatment of FOG in PD. Methods: Seventeen patients diagnosed with PD were recruited in a randomized, double-blinded, cross-over study. We applied high frequency rTMS (90% of resting motor threshold, 10 Hz, 1,000 pulses) over the lower leg primary motor cortex of the dominant hemisphere (M1-LL) for five sessions in a week. We also administered alternative sham stimulation with a two-week wash out period. The primary outcomes were measured before, immediately after, and one week after the intervention using the Standing Start 180° Turn Test (SS-180) with video analysis and the Freezing of Gait Questionnaire (FOG-Q). The secondary outcome measurements consisted of Timed Up and Go (TUG) tasks and the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III). Motor cortical excitability was also evaluated. Results: There were significant improvements in the step required to complete the SS-180 and FOG-Q in the rTMS condition compared to the sham condition, and the effects continued for a week. The TUG and UPDRS-III also showed significant ameliorations over time in the rTMS condition. The MEP amplitude at 120% resting motor threshold and intracortical facilitation also increased after real rTMS condition. Conclusions: High frequency rTMS over the M1-LL may serve as an add-on therapy for improving FOG in PD.

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Introduction The coronavirus disease 2019 (COVID-19) pandemic has disrupted everyday life of Parkinson's disease (PD) patients, but its clinical impact has not been illustrated. In this study, we investigated the change in physical activity and subsequently clinical symptoms of PD during the COVID-19 pandemic. Methods We enrolled PD patients who were able to ambulate independently and had visited our clinic at Samsung Medical Centre from December 2019 to January 2020 (baseline) and in May 2020 (follow-up during the COVID-19 crisis), and divided them into either ‘the sustained exercise group’ or ‘the reduced exercise group’. Then, we assessed the change in the exercise and clinical features between these two groups over the study period. Results A total of 100 subjects were recruited. During the COVID-19 pandemic, the amount, duration and frequency of exercise were reduced. There was decrease in number of patients who do indoor-solo exercise and increase in that of patients who do not exercise. One third reported subjective worsening of both motor and non-motor features, although Unified PD Rating Scale (UPDRS) part 3 score was similar. Additionally, the reduced exercise group reported more motor and non-motor aggravation than the sustained exercise group, despite lack of significant difference in the UPDRS part 3 score. Conclusion The COVID-19 pandemic had a clear impact on exercise and subjective symptoms in PD patients, with reduced exercise being related to a subjective increase in both motor and non-motor symptoms of PD. Maintaining exercise should therefore be emphasized even in situations like the COVID-19 pandemic.