Transcranial Magnetic Stimulation Promotes Gait Training in Parkinson Disease

Abstract

Objective: To determine whether priming with 1 or 25Hz repetitive transcranial magnetic stimulation (rTMS) will enhance the benefits from treadmill training up to 3 months postintervention in people with Parkinson disease (PD), and to evaluate the underlying changes in cortical excitability. Methods: This randomized double-blind, placebo-controlled trial was conducted between October 2016 and December 2018. Fifty-one participants with PD were randomized to receive 12 sessions of rTMS (25Hz, 1Hz, or sham) followed by treadmill training. All participants were assessed at baseline and 1 day, 1 month, and 3 months postintervention. Primary outcome was fastest walking speed, and secondary outcomes were timed up-and-go test (TUG), dual-task TUG (DT-TUG), motor section of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III), and electrophysiological evaluation of cortical excitability by TMS. Results: The 1 and 25Hz rTMS groups produced a greater improvement in fastest walking speed at 1 day and 3 months postintervention than the sham group. Only the 1 and 25Hz rTMS groups sustained the improvements in TUG, and had a significant improvement in DT-TUG and MDS-UPDRS-III for up to 3 months. Behavioral improvements correlated with increased cortical silent period and short-interval intracortical inhibition in both groups receiving real rTMS. Interpretation: Priming with 1 and 25Hz rTMS can augment the benefits of treadmill training and lead to long-term motor improvement up to 3 months postintervention. The motor improvement at follow-up was associated with a normalization of cortical excitability, which in turn suggests an alteration of the homeostatic plasticity range. Rebalancing cortical excitability by rTMS appears critical for plasticity induction.

Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation

“…Indeed, Ziemann et al [ 87 ] found that better outcomes on a thumb abduction movement training could be achieved when participants have received LTD-like plasticity-inducing brain stimulation prior to the training than without preconditioning. Recently, a study with Parkinson’s disease patients also demonstrated that the outcomes of motor learning were more significant and sustainable after preconditioning with rTMS compared to without preconditioning [ 88 ].…”

Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson’s Disease: A Meta-Analysis

“…Finally, 32 articles were included according to the pre-determined inclusion criteria (Figure 1) (Table 1 and Table 2). 10-43…”

“…The distinct results can be due to the difference in the included trials and data extraction, as several positive-result studies published in recent years. 15,23,33,43 The novel dTMS was also included in the analysis, and the result showed a significant motor function improvement, which can be attributed to the deep and wide stimulation area. Besides, consistent with the previous reports, we found multiple-session is the better choice for the long-term benefit and more permanent changes.…”

“…Several controlled and uncontrolled studies have validated the therapeutic effect of rTMS on PD, 10-43 especially on motor symptoms. However, most of them have involved small sample sizes and vary greatly in outcome measures, inclusion/exclusion criteria, methods of sham-TMS, and monitoring safety and tolerability.…”

Gaps and roadmap of novel neuromodulation targets for treatment of gait in Parkinson’s disease

“…Prolonged stimulation or combined targets 63 might be more efficacious but need to be further explored. Another promising approach is the use of TMS prior to a training intervention (e.g., prior to physiotherapy or treadmill) 66 . In these cases, the rationale is to strength the effectiveness of synaptic connections and recruit fibers required to improve performance during a given task such as gait 67 .…”