Efficacy of cumulative high-frequency rTMS on freezing of gait in Parkinson’s disease

Kim, Min Su; Chang, Won Hyuk; Cho, Jin Whan; Youn, Jinyoung; Kim, Yun Kwan; Kim, Sun Woong; Kim, Yun-Hee

doi:10.3233/rnn-140489

Cited by 72 publications

(124 citation statements)

References 34 publications

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“…Despite of the cortico‐cortical connections with the parietal and premotor cortices’ involvement in visuo‐motor control of action and the crucial role of DLPFC in the cognitive control of motor behavior (Kim et al., ), our meta‐analysis did not show significant motor benefit after rTMS over the DLPFC in terms of the UPDRS‐III scores. Other studies showed no effect of rTMS over DLPFC on clinical Parkinsonian symptoms, motor performance of ballistic wrist movements,or synergistic effects of motor signs improvement of rTMS over DLPFC+M1 (Conditions TNCCfC, ).…”

Section: Discussioncontrasting

confidence: 66%

“…There was insufficient information to categorize the blind procedure in two studies (del Olmo et al., ; Sedlackova et al., ). Nine studies (Benninger et al., , ; Brys et al., ; Hamada et al., ; Khedr et al., ; Kim et al., ; Lomarev et al., ; Sedlackova et al., ; Shirota et al., ) described the dropout number.…”

Section: Resultsmentioning

confidence: 99%

“…Kim et al. () reported that one patient had a mild headache which disappeared soon after the stop of rTMS. Lomarev et al.…”

Section: Resultsmentioning

confidence: 99%

“…Optimal parameters, however, have yet to be established. For example, many studies used rTMS protocols varying in stimulation parameters such as (a) stimulation sites of primary motor cortex (M1; Benninger et al., ; Bornke, Schulte, Przuntek, & Muller, ; Brys et al., ; Filipovic, Rothwell, van de Warrenburg, & Bhatia, ; Flamez et al., ; Khedr, Farweez, & Islam, ; Khedr, Rothwell, Shawky, Ahmed, & Hamdy, ; Kim et al., ; Lefaucheur et al., ; Maruo et al., ; Okabe, Ugawa, & Kanazawa, ; Siebner, Rossmeier, Mentschel, Peinemann, & Conrad, ; Yokoe et al., ) supplementary motor area (SMA; Brusa et al., ; Eggers, Günther, Rothwell, Timmermann, & Ruge, ; Hamada, Ugawa, & Tsuji, ; Koch et al., ; Shirota, Ohtsu, Hamada, Enomoto, & Ugawa, ; Yokoe et al., ) dorsal lateral prefrontal cortex (DLPFC; Brys et al., ; del Olmo, Bello, & Cudeiro, ; Nardone et al., ; Sedlackova, Rektorova, Srovnalova, & Rektor, ; Yokoe et al., ) the dorsal premotor (PMD; Sedlackova et al., ) and M1+ DLPFC (The M1+ DLPFC stimulation was considered as complex region stimulation; Benninger et al., ; Brys et al., ; Lomarev et al., ;) (b) LF‐rTMS (from 0.2 Hz to 1.0 Hz; Brusa et al., ; Filipovic et al., ; Flamez et al., ; Koch et al., ; Lefaucheur et al., ; Nardone et al., ; Okabe et al., ; Shirota et al., ) or HF‐rTMS (5.0 Hz: Hamada et al., ; Khedr et al., ; Koch et al., ; Siebner et al., , 10.0 Hz: Bornke et al., ; Brys et al., ; del Olmo et al., ; Khedr et al., ; Kim et al., ; Lefaucheur et al., ; Maruo et al., ; Shirota et al., ; Sedlackova et al., ; Yokoe et al., , 25.0 Hz: Lomarev et al., and 50.0 Hz: Benninger et al., ); (c) rTMS sessions: (one session: Bornke e...…”

Section: Introductionmentioning

confidence: 99%

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Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta‐analysis

et al. 2018

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IntroductionTherapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on motor recovery of Parkinson's disease (PD) have been reported; however, the protocols of these studies varied greatly. The aim of this meta‐analysis was to evaluate the optimal rTMS parameters for motor recovery of PD.MethodsElectronic databases were searched for studies investigating the therapeutic effects of rTMS on motor function in patients with PD. The section III of the Unified Parkinson's Disease Rating Scale (UPDRS) was extracted as the primary outcome, and the standardized mean difference (SMD) with 95% confidence interval (CI) was calculated.ResultsTwenty‐three studies with a total of 646 participants were included. The pooled estimates of rTMS revealed significant short‐term (SMD, 0.37; p < 0.00001) and long‐term (SMD, 0.39; p = 0.005) effects on motor function improvement of PD. Subgroup analysis observed that high‐frequency rTMS (HF‐rTMS) was significant in improving motor function (SMD, 0.48; p < 0.00001), but low‐frequency rTMS (LF‐rTMS) was not. In particular, when HF‐rTMS targeted over the primary motor cortex (M1), in which the bilateral M1 revealed a larger effect size than unilateral M1. Compared to single‐session, multi‐session of HF‐rTMS over the M1 showed significant effect size. In addition, HF‐rTMS over the M1 with a total of 18,000–20,000 stimulation pulses yielded more significant effects (SMD, 0.97; p = 0.01) than other dosages.ConclusionsIn conclusion, multi‐session of HF‐rTMS over the M1 (especially bilateral M1) with a total of 18,000–20,000 pulses appears to be the optimal parameters for motor improvement of PD.

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Section: Discussioncontrasting

confidence: 66%

Section: Resultsmentioning

confidence: 99%

“…Kim et al. () reported that one patient had a mild headache which disappeared soon after the stop of rTMS. Lomarev et al.…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta‐analysis

et al. 2018

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“…35, 36 Our cerebellar site, identified based on lesions that cause FOG, is also closely connected to the leg area of M1 (Figure 5A). This finding is consistent with the notion that targets of brain stimulation may be brain networks rather than single regions.…”

Section: Discussionmentioning

confidence: 81%

Lesions causing freezing of gait localize to a cerebellar functional network

Fasano

Laganiere

Lam

et al. 2017

Annals of Neurology

139

114

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Objective Freezing of gait is a disabling symptom in Parkinson’s disease and related disorders, but the brain regions involved in symptom generation remain unclear. Here we analyze brain lesions causing acute onset freezing of gait to identify regions causally involved in symptom generation. Methods Fourteen cases of lesion-induced freezing of gait were identified from the literature and lesions were mapped to a common brain atlas. Because lesion-induced symptoms can come from sites connected to the lesion location, not just the lesion location itself, we also identified brain regions functionally connected to each lesion location. This technique, termed lesion network mapping, has been recently shown to identify regions involved in symptom generation across a variety of lesion-induced disorders. Results Lesion location was heterogeneous and no single region could be considered necessary for symptom generation. However, over 90% (13/14) of lesions were functionally connected to a focal area in the dorsal medial cerebellum. This cerebellar area overlapped previously recognized regions that are activated by locomotor tasks, termed the cerebellar locomotor region. Connectivity to this region was specific to lesions causing freezing of gait compared to lesions causing other movement disorders (hemichorea or asterixis). Interpretation Lesions causing freezing of gait are located within a common functional network characterized by connectivity to the cerebellar locomotor region. These results based on causal brain lesions complement prior neuroimaging studies in Parkinson’s disease patients, advancing our understanding of the brain regions involved in freezing of gait.

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Effects of repetitive transcranial magnetic stimulation on gait disorders and cognitive dysfunction in Parkinson's disease: A systematic review with meta‐analysis

et al. 2022

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Background Repetitive transcranial magnetic stimulation (rTMS) is acknowledged to be crucial to manage freezing of gait (FOG) and cognitive impairment for patients with Parkinson's disease (PD), but its effectiveness is unclear. Objective To determine the effects of rTMS on FOG and cognitive function in people with PD and to investigate potential factors that modulate the rTMS effects. Methods Databases searched included PubMed, Web of Science, EMBASE, and the Cochrane Library from inception to December 31, 2021. Eligible studies include a controlled randomized clinical trial of rTMS intervention for FOG and cognitive dysfunction in PD patients. The weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated with fixed‐effects models. The outcome of the study included gait and cognitive assessments. Results Sixteen studies with a total of 419 patients were included. Fixed‐effects analysis revealed that rTMS was effective in improving freezing of gait questionnaire scores (short‐term effect: WMD = −0.925, 95% CI: −1.642 to −0.209, p = .011; long‐term effect: WMD = −2.120, 95% CI: −2.751 to −1.489, p = .000), 10‐m walking time (short‐term effect: WMD = −0.456, 95% CI: −0.793 to −0.119, p = .008; long‐term effect: WMD = −0.526, 95% CI: −0.885 to −0.167, p = .004), Timed Up‐and‐Go scores (short‐term effect: WMD = −1.064, 95% CI: −1.555 to −0.572, p = .000; long‐term effect: WMD = −1.097, 95% CI: −1.422 to −0.772, p = .000), Montreal cognitive assessment (WMD = 3.714, 95% CI: 2.567 to 4.861, p = .000), and frontal assessment battery (WMD = −0.584, 95% CI: −0.934 to −0.234, p = .001). Conclusions RTMS showed a beneficial effect on FOG and cognitive dysfunction in parkinsonism. However, the optimal rTMS protocol has not been determined and further high‐quality studies are needed.

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Efficacy of cumulative high-frequency rTMS on freezing of gait in Parkinson’s disease

Cited by 72 publications

References 34 publications

Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta‐analysis

Repetitive transcranial magnetic stimulation therapy for motor recovery in Parkinson's disease: A Meta‐analysis

Lesions causing freezing of gait localize to a cerebellar functional network

Effects of repetitive transcranial magnetic stimulation on gait disorders and cognitive dysfunction in Parkinson's disease: A systematic review with meta‐analysis

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