Background. Repetitive transcranial magnetic stimulation (rTMS) is a promising therapeutic tool for Parkinson’s disease (PD), and many stimulation targets have been implicated. We aim to explore whether low-frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) improves motor and nonmotor symptoms of individuals with PD. Methods. We conducted a randomized, single-blind, sham-controlled parallel trial to compare the effect of 10 consecutive daily sessions of 1 Hz rTMS over right DLPFC on individuals with idiopathic PD between active and sham rTMS group. Primary outcomes were changes in Unified Parkinson’s Disease Rating Scale (UPDRS) part III and Nonmotor Symptom Questionnaire (NMSQ). Secondary outcomes were changes in UPDRS total score, Hamilton Rating Scale for Depression (HRSD), Pittsburgh Sleep Quality Index (PSQI), and Montreal Cognitive Assessment (MoCA). Assessments were completed at baseline, after treatment, and at 1 month, 3 months, and 6 months after treatment. Results. A total of 33 participants with PD were randomized. All participants completed the study and no severe adverse effect was noticed. Compared to baseline, active rTMS showed significant improvements in UPDRS part III and NMSQ at 1 month. Change of scores on UPDRS part III, HRSD, and PSQI persisted for 3 months after rTMS intervention. The beneficial effect on cognitive performance assessed by MoCA was maintained for at least 6 months in the follow-up. No significant changes were observed in the group with sham rTMS. Conclusions. Low-frequency rTMS of right DLPFC could be a potential selection in managing motor and nonmotor symptoms in PD.

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Background Transcranial magnetic stimulation (TMS) is a noninvasive tool to improve cognition. Relevant clinical studies are mainly focused on neurological and psychiatric diseases. However, cognition decline and psychiatric disorders are popular in obstructive sleep apnea (OSA) patients. We aimed to investigate the effect of TMS over the left dorsolateral prefrontal cortex (DLPFC) on cognition test performance and to compare the changes in quantitative electroencephalogram (EEG) before and after stimulation for OSA. Methods This study recruited 42 OSA patients diagnosed with polysomnography according to American Academy of Sleep Medicine guidelines. TMS (intermittent theta‐burst stimulation paradigm; 2 s on, 8 s off, 600 pulses*3, intermittent 15 min) was performed on the DLPFC. Cambridge Automated Neuropsychological Test Battery was used to assess cognitive performance. EEG oscillations were computed via power spectral density with MATLAB software. Results Real‐TMS group displayed a significant improvement in visual memory, sustain attention performance, as well as the outcome of working memory. However, the executive function of latency was changed in both groups. Furthermore, TMS resulted in a significant increase in the relative power spectral density of the theta band and beta band in the parietal, temporal, and anterior regions, respectively. Conclusions In summary, our findings indicate that TMS can safely modulate cortical oscillations and improve cognition in OSA patients. In the future, TMS can be utilized as an alternative treatment option to improve cognition in OSA patients.

Objective: Periodic Limb Movements of Sleep (PLMS) is a poorly understood comorbidity with close association to Obstructive Sleep Apnea (OSA). The mechanistic link between the two is unclear. Recent studies on the latter have uncovered low respiratory arousal threshold as an important non-anatomical cause of the disorder. This study sought to investigate whether periodic limb movements are associated with the low respiratory arousal threshold (ArTH) in OSA.Methods: Retrospective data on 720 OSA patients (mean age = 47.0) who underwent Polysomnography (PSG) were collected. Patients were divided into the OSA-PLMS group (n=116) and the OSA-only group (n=604). Multiple logistic regression analysis was used to examine the correlation between PLMS and its potential risk factors including clinical variables, polysomnographic parameters as well as low ArTH. The resulting model was validated in the external MrOS database.Results: The patients in the OSA-PLMS group tend to be older, with a higher prevalence of hypertension, diabetes, and stroke. Significant predictors of PLMS included age, diabetes, proportion of Stage N1 Sleep, average SaO₂, and low respiratory arousal threshold (OR=5.51 (3.35-9.05), p<0.001). When validated against the MrOS database, low ArTH remained a significant predictor of PLMS with an odds ratio of 1.46 (1.18-1.81, p < 0.001).Interpretation: This is the first study that demonstrated a strong correlation between PLMS and low respiratory arousal threshold. This suggests a possible mechanistic link between the physical manifestations of PLMS and the non-anatomical low arousal threshold phenotype in OSA.