Improvement in Parkinsonian symptoms after repetitive transcranial magnetic stimulation

Transcranial magnetic stimulation and brain atrophy: a computer-based human brain model study

“…When this current is applied repetitively, repetitive transcranial magnetic stimulation (rTMS), it can modulate cortical excitability, decreasing or increasing it, depending on the parameters of stimulation. Since its inception, researchers have proposed the use of TMS and rTMS to study and treat neuropsychiatric diseases, such as major depression George et al 2000;Martin et al 2003;Holtzheimer et al 2004;Rumi et al 2005), schizophrenia (Hoffman et al 2003;Lee et al 2005), Parkinson's disease (Mally and Stone 1999;de Groot et al 2001;Khedr et al 2003;Fregni et al 2004;Lefaucheur et al 2004), dystonia (Huang et al 2004), epilepsy (Tergau et al 1999;Menkes and Gruenthal 2000;Daniele et al 2003;Fregni et al 2005) and the acute or chronic sequels derived from stroke ). However, a fundamental question that needs to be addressed before the wide-spread use of TMS in clinical practice, is how the modification of brain anatomy and tissue properties caused by certain neuropsychiatric diseases can alter the effects of TMS.…”

Transcranial Magnetic Stimulation Treatment for Motor Symptoms in Parkinson’s Disease: A Review of Two Decades of Studies

“…We decided to include only studies focusing on motor symptoms, therefore studies employing neuropsychological testing, mood rating scales, voice and speech rating scales and cortical excitability or neurotransmitter levels measures were excluded. Most studies focused on three regions: M1, SMA and DLPFC [ Table 1-3], while fewer targeted other areas [36,61,[64][65][66][67][68][ Table 4]. Nine studies [32][33][34]39,45,52,54,55,63] tested the effects of only one rTMS session, while the remaining administered a higher number of sessions, ranging from 2 to 20.…”

“…Sample sizes were generally under 30 subjects, except for five studies [36,40,57,58,64]. In regard to outcome measures, the Unified Parkinson's Disease Rating Scale -Section III (UPDRS-III) was the most employed measure (33 of 40 studies) [32][33][34][36][37][38][39][40][41][42][43][44][47][48][49][50][51][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68], yet some studies employed other motor function measures such as movement and reaction time [29,30,35], Grooved Pegboard test for fine movement [31], pointing, pronation supination, Purdue Pegboard Test [45], movement frequency [46] and gait kinematics [52].…”

“…All studies except for the abovementioned one [61] delivered a low number of pulses, ranging from 30 to 100, although in repeated sessions. Three studies [64][65]68] targeted the vertex of the skull: the first 2 studies [64][65], conducted by the same authors, reported significant improvements in motor symptoms as suggested by the decrease in UPDRS scores, while the latter [68] found no differences between real and sham stimulation groups and suggested the lack of therapeutic value of this stimulation protocol, which should have been abandoned.…”

Combining functional imaging with brain stimulation in Parkinson's disease

“…A number of studies have reported a therapeutic effect of rTMS in PD. rTMS can transiently infl uence PD abnormal motor functions (Filipovic et al, 2010;Hamada et al, 2008;Helmich et al, 2006;Khedr et al, 2006;Lefaucheur et al, 2004;Mally & Stone, 1999a, 1999bPal et al, 2010;Siebner et al, 2003) with a selective improvement for levodopa-induced dyskinesias (Filipovic et al, 2009;Koch et al, 2005Koch et al, , 2009, especially when high stimulation frequencies are used (Lefaucheur et al, 2004). rTMS at 1 Hz may also elicit a sustained or prolonged change in PD cortex excitability as revealed by a longer silent period duration (Filipovic et al, 2010) suggestive of an infl uence on GABA activity.…”