Previous studies in patients with Parkinson's disease have reported that a single session of repetitive transcranial magnetic stimulation (rTMS) can improve some or all of the motor symptoms for 30 to 60 minutes. A recent study suggested that repeated sessions of rTMS lead to effects that can last for at least 1 month. Here we report data that both confirm and extend this work. Fifty-five unmedicated PD patients were classified into four groups: two groups (early and late PD) received 25 Hz rTMS bilaterally on the motor arm and leg areas; other groups acted as control for frequency (10 Hz) and for site of stimulation (occipital stimulation). All patients received six consecutive daily sessions (3,000 pulses for each session). The first two groups then received a further three booster sessions (3 consecutive days of rTMS) after 1, 2, and 3 months, while the third group had only one additional session after the first month. Unified Parkinson's Disease Rating Scale (UPDRS), walking time, key-tapping speed, and self-assessment scale were measured for each patient before and after each rTMS session and before and after the monthly sessions. Compared to occipital stimulation, 25 Hz rTMS over motor areas improved all measures in both early and late groups; the group that received 10 Hz rTMS improved more than the occipital group but less than the 25 Hz groups. The effect built up gradually during the sessions and was maintained for 1 month after, with a slight reduction in efficacy. Interestingly, the effect was restored and maintained for the next month by the booster sessions. We conclude that 25 Hz rTMS can lead to cumulative and long-lasting effects on motor performance.

A brief course of 2 types of tDCS stimulation is superior to sham stimulation in enhancing the effect of rehabilitation training to improve motor recovery after stroke.

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Background and Aim: Few comprehensive epidemiological studies of the prevalence of tinnitus have been undertaken, and none has been carried out in Egypt. A community-based survey was conducted in the Assiut Governorate to estimate the prevalence of tinnitus, its associations with psychiatric disorders and its effect on the quality of life. Material and Methods: The study involved 8,484 subjects, 5,783 (68.2%) from the rural community and 2,701 (31.8%) from the urban community. Patients were identified from a door-to-door survey and evaluated using a semistructured questionnaire, the Tinnitus Handicap Inventory and the Hamilton Anxiety and Depression Scales. Results: Four hundred and thirty-nine patients with tinnitus were found, giving a prevalence of 5.17 tinnitus cases/100 inhabitants. Males and females were equally affected. The highest age-specific prevalence rate was recorded among subjects above 60 years (17.66%) and was significantly higher among urban than rural inhabitants (6.3 vs. 4.6%) and among illiterate than among educated persons (10.15 vs. 3.07%). A majority of patients (53.3%) had some hearing loss; otitis media was common. Only 15.2% of cases were classified as having severe to catastrophic tinnitus. Nearly two thirds had a degree of depression. There were significant correlations between the severity of tinnitus and the degree of hearing loss, temporomandibular joint pain and the Hamilton depression score. Sleep disturbance was reported by 39.4% of subjects. Life enjoyment was severely affected in 15% of tinnitus patients. Conclusion: Tinnitus is a common problem in our locality, especially in older adults, and is associated with some modifiable risk factors.

Improved motor performance in PD after repeated session of rTMS may be related to an elevation of serum dopamine concentration.