To investigate whether a period of 1 Hz repetitive transcranial magnetic stimulation (rTMS) over M1 preconditioned by tDCS improves bradykinesia of the upper limb in Parkinson's disease (PD). Fifteen patients with PD performed index finger, hand tapping and horizontal pointing movements as well as reach-to-grasp movements with either hand before (baseline conditions) and after a period of 1 Hz rTMS preconditioned by (1) sham, (2) anodal or (3) cathodal tDCS over the primary motor cortex contralateral to the more affected body side. Movement kinematics was analysed using an ultrasound-based motion analyser at baseline, immediately after and 30 min after each stimulation session. Dopaminergic medication was continued. Compared to baseline, 1 Hz rTMS significantly increased the frequency of index finger and hand tapping as well as horizontal pointing movements performed with the contralateral hand. Movement frequency increased up to 40% over 30 min after cessation of the stimulation. Preconditioning with cathodal tDCS, but not with anodal tDCS, reduced the effectiveness of 1 Hz rTMS to improve tapping and pointing movements. There was no significant increase of movement frequencies of the ipsilateral hand induced by 1 Hz rTMS preconditioned by either tDCS session. Movement kinematics of reach-to-grasp movements were not significantly influenced by either stimulation session. In PD the beneficial effects of 1 Hz rTMS over the primary motor cortex on bradykinesia of simple finger, hand and pointing movements is reduced by preconditioning with cathodal tDCS, but not with anodal tDCS. Preconditioning with tDCS is a powerful tool to modulate the behavioural effect of 1 Hz rTMS over the primary motor cortex in PD.
This study investigated whether a period of low frequency rTMS preconditioned by tDCS over the primary motor cortex modulates control of grip force in Parkinson's disease. The presented results are from the same patient cohort tested in an earlier study (Gruner et al. J Neural Transm 2010: 117: 207-216). 15 patients with Parkinson's disease (mean age: 69 ± 8 years; average disease duration: 5 ± 3 years) on dopaminergic drugs performed a grasp-lift task with either hand before (baseline) and after a period of 1Hz rTMS (90% of the resting motor threshold; 900 pulses) preconditioned by sham, anodal or cathodal tDCS (1mA, 10 min) over the primary motor cortex. We found that compared with baseline, none of the grip force parameters was significantly influenced by either stimulation session and concluded that grasping is a higher order motor skill, which cannot be modulated by tDCS preconditioned 1Hz rTMS in PD.
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