Facilitatory rTMS over the Supplementary Motor Cortex Impedes Gait Performance in Parkinson Patients with Freezing of Gait

Abstract

Freezing of gait (FOG) in Parkinson’s disease (PD) occurs frequently in situations with high environmental complexity. The supplementary motor cortex (SMC) is regarded as a major network node that exerts cortical input for motor control in these situations. We aimed at assessing the impact of single-session (excitatory) intermittent theta burst stimulation (iTBS) of the SMC on established walking during FOG provoking situations such as passing through narrow spaces and turning for directional changes. Twelve PD patients with FOG underwent two visits in the off-medication state with either iTBS or sham stimulation. At each visit, spatiotemporal gait parameters were measured during walking without obstacles and in FOG-provoking situations before and after stimulation. When patients passed through narrow spaces, decreased stride time along with increased stride length and walking speed (i.e., improved gait) was observed after both sham stimulation and iTBS. These effects, particularly on stride time, were attenuated by real iTBS. During turning, iTBS resulted in decreased stride time along with unchanged stride length, a constellation compatible with increased stepping frequency. The observed iTBS effects are regarded as relative gait deterioration. We conclude that iTBS over the SMC increases stepping frequency in PD patients with FOG, particularly in FOG provoking situations.

Effect of Theta Burst Stimulation-Patterned rTMS on Motor and Nonmotor Dysfunction of Parkinson's Disease: A Systematic Review and Metaanalysis

“…After screening the titles and abstracts, 375 records were excluded as they did not meet the inclusion criteria (“PICOS”) in our work, and we determined 59 articles for full-text reading. Finally, eight studies were included in our metaanalysis ( 23 – 25 , 28 – 30 , 32 , 34 ). The literature selection is presented in Figure 1 .…”

“…Four studies ( 24 , 25 , 30 , 32 ) were parallel-controlled and four studies ( 23 , 28 , 29 , 34 ) were crossover-controlled. Five studies gave single-session ( 23 , 25 , 28 , 29 , 34 ) and three studies gave multiple sessions (total of six to 42 sessions) ( 24 , 30 , 32 ).…”

“…Four studies ( 24 , 25 , 30 , 32 ) were parallel-controlled and four studies ( 23 , 28 , 29 , 34 ) were crossover-controlled. Five studies gave single-session ( 23 , 25 , 28 , 29 , 34 ) and three studies gave multiple sessions (total of six to 42 sessions) ( 24 , 30 , 32 ). Four studies evaluated the immediate effects after TBS using clinical symptom assessment scales ( 23 , 25 , 28 , 29 , 34 ), and three studies conducted a follow-up of clinical effects range from 1 week to 1 month after TBS intervention ( 24 , 30 , 32 ).…”

“…Five studies gave single-session ( 23 , 25 , 28 , 29 , 34 ) and three studies gave multiple sessions (total of six to 42 sessions) ( 24 , 30 , 32 ). Four studies evaluated the immediate effects after TBS using clinical symptom assessment scales ( 23 , 25 , 28 , 29 , 34 ), and three studies conducted a follow-up of clinical effects range from 1 week to 1 month after TBS intervention ( 24 , 30 , 32 ). Two studies assessed the therapeutic effects of TBS only in the “on” anti-Parkinsonism medicine state ( 29 , 51 ).…”

“…Two studies assessed the therapeutic effects of TBS only in the “on” anti-Parkinsonism medicine state ( 29 , 51 ). While, two studies evaluated only in the “off” medicine status (under the anti-Parkinsonism medicine withdrawal status for at least 12 hours) ( 23 , 34 ). Besides, four studies assessed the therapeutic effects of TBS both in the “on” and “off” medicine state ( 24 , 25 , 28 , 32 ).…”