Controlled Study of 50-Hz Repetitive Transcranial Magnetic Stimulation for the Treatment of Parkinson Disease

Abstract

Objective To investigate the safety and efficacy of 50Hz repetitive Transcranial Magnetic Stimulation(rTMS) in the treatment of motor symptoms in Parkinson’s disease(PD). Background Progression of PD is characterized by the emergence of motor deficits, which eventually respond less to dopaminergic therapy and pose a therapeutic challenge. RTMS has shown promising results in improving gait, a major cause of disability, and may provide a therapeutic alternative. Controlled studies suggest increasing stimulation frequency might enhance therapeutic efficacy. Methods In this randomized, double blind, sham-controlled study, we investigated safety and efficacy of 50Hz-rTMS of the motor cortices in 8sessions over 2weeks. Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia, UPDRS and additional clinical, neurophysiological and neuropsychological parameters. In addition, safety of 50Hz-rTMS was tested with EMG-EEG-monitoring during and after stimulation. Results We investigated 26 patients with mild to moderate PD: 13 received 50Hz-rTMS and 13 sham-stimulation. 50Hz-rTMS did not improve gait, bradykinesia, global and motor UPDRS, but there appeared a short-lived “on”-state improvement in activities of daily living (UPDRS II). 50Hz-rTMS lengthened the cortical silent period, but other neurophysiology and neuropsychological measures remained unchanged. EMG/EEG recorded no pathological increase of cortical excitability or epileptic activity. There were no adverse effects. Conclusion 50Hz-rTMS of the motor cortices appears safe, but fails to improve motor performance and functional status in PD. Prolonged stimulation or other techniques with rTMS might be more efficacious, but need to be established in future research.

Transcranial Magnetic Stimulation Treatment for Motor Symptoms in Parkinson’s Disease: A Review of Two Decades of Studies

“…Nevertheless, the magnitude of effects varied significantly across studies, probably due to the heterogeneity between stimulation protocols (in terms of frequency, intensity, duration) and targeted regions. Moreover, many studies were not sham-controlled and for sham-controlled studies, different methods of sham stimulation have been used: tilted [33,37,54,56,60,62], sham [39,47,63] and inactive coils [50,66,68] have been used, as well as occipital stimulation [40,49,61], coil back surface [41] and realistic sham [51,57,58]. A very recent review [69] examined 20 RCTs of rTMS treatment for motor dysfunction in PD to evaluate the efficacy of treatment and identify protocols factors that moderate the effects of treatment.…”

“…Sample sizes were generally under 30 subjects, except for five studies [36,40,57,58,64]. In regard to outcome measures, the Unified Parkinson's Disease Rating Scale -Section III (UPDRS-III) was the most employed measure (33 of 40 studies) [32][33][34][36][37][38][39][40][41][42][43][44][47][48][49][50][51][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68], yet some studies employed other motor function measures such as movement and reaction time [29,30,35], Grooved Pegboard test for fine movement [31], pointing, pronation supination, Purdue Pegboard Test [45], movement frequency [46] and gait kinematics [52].…”

“…Nine studies [32][33][34]39,45,52,54,55,63] tested the effects of only one rTMS session, while the remaining administered a higher number of sessions, ranging from 2 to 20. Most studies, especially those targeting M1, SMA and DLPFC, administered high-frequency stimulation (24 of 40 studies) [29][30][31][32][33][34][37][38][40][41][42][43][44][49][50][51][53][54][55][57][58][60][61][62], while lowfrequency stimulation was employed primarily in studies targeting other regions. The intensity of stimulation ranged from 20% of motor threshold to 120%.…”

Repetitive transcranial magnetic stimulation in neurology and psychiatry

“…[60][61][62][63], не позволяю-щие сделать заключение об однозначной эффективности высокочастотной односторонней стимуляции при БП.…”

Transcranial magnetic stimulation in Parkinson’s disease

“…В ходе недавно проведенного рандомизирован-ного двойного слепого плацебо-контролируемого исследования изучались безопасность и эффектив-ность проведения ТКМС с частотой 50 Гц у 26 паци-ентов с ранними стадиями БП [29]. Было выявлено отсутствие положительного влияния на походку, выраженность брадикинезии, также не было выра-женного улучшения двигательной активности со-гласно шкале UPDRS, но был обнаружен незначи-тельный положительный эффект в виде улучшения в повседневной деятельности (часть II шкалы UPDRS).…”