Motor recovery and antidepressant effects of repetitive transcranial magnetic stimulation on Parkinson disease

Li, Shuqian; Jiao, Rui; Zhou, Xiaomei; Chen, Shangjie

doi:10.1097/md.0000000000019642

Cited by 24 publications

(21 citation statements)

References 48 publications

(49 reference statements)

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“…The H-coil has been designed to stimulate a wider area of effective cortical stimulation compared with the standard coils ( 8 ); considering the widespread cortical dysfunction in PD ( 9 ), this could be seen as a possible advantage and not as a limitation. In fact, positive results have been achieved in PD using the focal coil with sequential bilateral stimulation of M1, and possibly associating M1 and DLPFCstimulation ( 2 , 5 , 10 – 12 ). Moreover, an open-label pilot study performed by our group showed that high-frequency rTMS stimulation of bilateral M1 and PFC with H-coil might serve as a safe and effective treatment for PD ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

Bilateral Repetitive Transcranial Magnetic Stimulation With the H-Coil in Parkinson's Disease: A Randomized, Sham-Controlled Study

et al. 2021

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Background: Pilot open-label application of high-frequency repetitive transcranial magnetic stimulation (rTMS) with H-coil in Parkinson's Disease (PD) have shown promising results.Objective: To evaluate safety and efficacy of high-frequency rTMS with H-coil in PD in a double-blind, placebo-controlled, randomized study.Methods: Sixty patients with PD were randomized into 3 groups: M1-PFC (real stimulation on primary motor-M1 and pre-frontal cortices-PFC), M1 (real rTMS on M1, sham on PFC), Sham (apparent stimulation). Primary outcome was baseline-normalized percent improvement in UPDRS part III OFF-therapy at the end of treatment (12 rTMS sessions, 4 weeks). Secondary outcomes were improvement in UPDRS part III sub-scores, timed tests, and neuropsychological tests. Statistical analysis compared improvement following real and sham stimulation at the end of the protocol using either a t-test or a Mann-Whitney test.Results: All patients tolerated the treatment and concluded the study. One patient from M1-PFC group was excluded from the analysis due to newly discovered uncontrolled diabetes mellitus. No serious adverse effect was recorded. At the end of treatment, patients receiving real rTMS (M1-PFC and M1 combined) showed significantly greater improvement compared to sham in UPDRS part III total score (p = 0.007), tremor subscore (p = 0.011), and lateralized sub-scores (p = 0.042 for the more affected side; p = 0.012 for the less affected side). No significant differences have been oserved in safety and efficacy outcomes between the two real rTMS groups. Notably, mild, not-distressing and transient dyskinesias occurred in 3 patients after real rTMS in OFF state.Conclusions: The present findings suggest that high-frequency rTMS with H-coil is a safe and potentially effective procedure and prompt larger studies for validation as add-on treatment in PD.

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Section: Introductionmentioning

confidence: 99%

Bilateral Repetitive Transcranial Magnetic Stimulation With the H-Coil in Parkinson's Disease: A Randomized, Sham-Controlled Study

et al. 2021

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“…High-frequency rTMS was more effective than low-frequency rTMS. The improvement was greater under off-medication conditions (SMD 2.98) than under on-medication conditions (SMD 1.51) 15 . This is mostly in agreement with a previous 2018 meta-analysis on 23 trials, in which significant motor benefit from high-frequency M1 and SMA stimulation was reported, with greater effect from the former, while non-motor effects were demonstrated using low-frequency rTMS or stimulation over the DLPFC 16 .…”

Section: Transcranial Magnetic Stimulationmentioning

confidence: 80%

“…The motor effects of rTMS have been subjected to several meta-analyses. The most recent of these included 28 randomized controlled or crossover trials up to July 2019, with 25 trials evaluating motor symptoms in a total of 787 patients 15 . Only five rTMS studies were published subsequently, and these are discussed individually.…”

Section: Transcranial Magnetic Stimulationmentioning

confidence: 99%

“…This showed distinct effect magnitudes, measured using the standard mean difference (SMD). Per stimulation site, the primary motor cortex (M1) had the highest SMD compared with placebo, with 2.22; followed by the dorsal lateral prefrontal cortex (DLPFC) with 1.42; and the SMA and a combination of M1 + DLPFC, both with reported SMD of 1.27 15 . High-frequency rTMS was more effective than low-frequency rTMS.…”

Section: Transcranial Magnetic Stimulationmentioning

confidence: 99%

“…Regarding non-motor symptoms, the most recent metaanalysis with rTMS, on depression in the setting of PD, included eight trials comprising a total of 331 patients 15 . Like non-PD depression patients, left DLPFC stimulation was found to be effective for the improvement of depression scores (SMD 1.64), which was consistent with a previous meta-analysis 23 .…”

Section: Transcranial Magnetic Stimulationmentioning

confidence: 99%

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Use of non-invasive stimulation in movement disorders: a critical review

Godeiro-Júnior

França

Carra

et al. 2021

Arq. Neuro-Psiquiatr.

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Background: Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. Objective: In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. Methods: A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. Results: Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson’s disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. Conclusions: There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

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Accelerated Transcranial Ultrasound Neuromodulation in Parkinson's Disease: A Pilot Study

Samuel,

Ding,

Sarica

et al. 2023

Movement Disorders

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ObjectiveLow‐intensity transcranial focused ultrasound (TUS) is a novel method for neuromodulation. We aimed to study the feasibility of stimulating the bilateral primary motor cortices (M1) with accelerated theta‐burst TUS (a‐tbTUS) on neurophysiologic and clinical outcomes in Parkinson's disease (PD).MethodsPatients were randomly assigned to receive active or sham a‐tbTUS for the first visit and the alternate condition on the second visit, at least 10 days apart. a‐tbTUS was administered in three consecutive sonications at 30‐minute intervals. We used an accelerated protocol to produce an additive effect of stimulation. Patients were studied in the OFF‐medication state. Transcranial magnetic stimulation (TMS)‐elicited motor‐evoked potentials (MEPs) were used to assess motor cortical excitability before and after TUS. Clinical outcomes after a‐tbTUS administration were assessed using the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS‐UPDRS)‐III.ResultsA total of 20 visits were conducted in 10 PD patients. Compared to the baseline, TMS‐elicited MEP amplitudes significantly increased following active but not sham sonication (P = 0.0057). MEP amplitudes were also higher following a‐tbTUS than sham sonication (P = 0.0064). There were no statistically significant changes in MDS‐UPDRS‐III scores with active or sham a‐tbTUS.Conclusionsa‐tbTUS increases motor cortex excitability and is a feasible non‐invasive neuromodulation strategy in PD. Future studies should determine optimal dosing parameters and the durability of neurophysiologic and clinical outcomes in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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Motor recovery and antidepressant effects of repetitive transcranial magnetic stimulation on Parkinson disease

Abstract: Supplemental Digital Content is available in the text

Cited by 24 publications

References 48 publications

Bilateral Repetitive Transcranial Magnetic Stimulation With the H-Coil in Parkinson's Disease: A Randomized, Sham-Controlled Study

Bilateral Repetitive Transcranial Magnetic Stimulation With the H-Coil in Parkinson's Disease: A Randomized, Sham-Controlled Study

Use of non-invasive stimulation in movement disorders: a critical review

Accelerated Transcranial Ultrasound Neuromodulation in Parkinson's Disease: A Pilot Study

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