Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation in Spinocerebellar Ataxia Type 3: a Systematic Review and Meta‑analysis of Randomized Controlled Trials

Effects of cerebellar repetitive transcranial magnetic stimulation plus physiotherapy in spinocerebellar ataxias – A randomized clinical trial

“…In this randomized, double blind, sham‐controlled trial, we demonstrate the positive effects of cerebellar rTMS in combination with intensified symptomatic physiotherapy on ataxia severity in SCA patients. The strengths of this study include the use of neuro‐navigation for improved target localization, which is still rare in TMS studies, 11 the genetically determined study cohort and application of additional symptomatic physiotherapy in both treatment groups. All assessments were performed by SARA‐trained and certified investigators.…”

“…The effect of TMS on cerebellar ataxia has been positively reviewed in three publications. 11 , 23 , 26 However, the reviewed studies used different stimulation protocols (excitatory and inhibitory) and study designs (from case reports to randomized controlled trials) and the positive effects were attributed to different aspects of the symptom ataxia. Wang and colleagues reviewed 8 qualitatively heterogeneous TMS studies in patients with mixed cerebellar ataxias (three of the reviewed studies included cerebellar strokes as cause of ataxia).…”

“…Qui and colleagues reviewed 6 studies with cumulatively 157 SCA3 patients and a treatment duration between 2 and 4 weeks. 11 The included studies partly overlapped with those from Wang and colleagues, 17 , 18 but the quality of the included studies was generally higher and focused on a more homogenous cohort. Their meta‐analysis showed a mean reduction of 1.59 SARA points, which seems to be a more realistic estimation of treatment effects.…”

“… 5 , 6 , 7 , 8 , 9 In the absence of drug therapy options, non‐invasive brain‐stimulation (NIBS) is an exciting and promising therapeutic option with a good safety profile. 10 , 11 Using transcranial magnetic stimulation (TMS), the cerebellar output can be modified indirectly by stimulating or inhibiting the Purkinje cells in the cerebellar cortex, 12 , 13 , 14 , 15 particularity lobules VI–VIII. 14 , 15 This effect can be prolonged significantly using repetitive TMS pulses (rTMS).…”

“… 17 , 18 , 19 , 20 , 21 , 22 Interestingly, stimulatory and inhibitory cerebellar TMS protocols have been tested in cerebellar ataxias, both with reported positive effects on motor function. 11 , 23 The stimulation protocols used (stimulation frequency and duration), the number of patients and the study design are, however, very heterogeneous. The duration of most stimulation protocols lay between 2 and 4 weeks.…”