Excitatory Deep Repetitive Transcranial Magnetic Stimulation With H-coil as Add-on Treatment of Motor Symptoms in Parkinson's Disease: An Open Label, Pilot Study

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

“…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%.…”

“…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].…”

“…25 studies [ Table 1] focused on M1 as target area: 4 of these [36,41,43,53] One of these studies [53] employed a deep TMS (dTMS) protocol with an Hcoil to stimulate motor and prefrontal cortices: the authors found a significant UPDRS-III improvement after treatment. The remaining 6 studies [31,32,36,43,45,47] found no significant improvements after rTMS treatment: Ghabra et al [31] found no significant effect of highfrequency rTMS on fine movement in 11 PD patients.…”

“…One randomized, double-blind, sham-controlled, multicenter study with a parallel design [58] provided Class 1 evidence for the effectiveness of 1 Hz rTMS over the SMA for motor symptoms in PD: low-frequency stimulation was compared to both highfrequency and sham stimulation and the effects were monitored for up to 20 weeks: at this time, results showed 6.84-point improvement of the UPDRS part III in the 1-Hz group, while sham stimulation and 10-Hz rTMS improved motor symptoms transiently, but their effects disappeared during the observation period. [41,43,53,61] provided multiple targets stimulations. All studies except one [63] employed high-frequency stimulation, UPDRS-III as outcome measure and more than one session of rTMS.…”

“…All studies except one [63] employed high-frequency stimulation, UPDRS-III as outcome measure and more than one session of rTMS. Only two of the multiple targets studies found some degree of improvement after rTMS treatment: cumulative benefits due to the stimulation of both M1 and DLPFC in each session (300 pulses for each of 4 target areas: left and right M1, left and right DLPFC) were found [41], as well as UPDRS-III improvements after dTMS stimulation with a double target protocol (840 pulses on M1 and 840 pulses on PFC) [53]. The remaining studies [43,[60][61][62][63] failed to find any improvements in motor function after rTMS treatment.…”