Kontralaterale und ipsilaterale repetitive transkranielle Magnetstimulation bei Parkinson-Patienten

Abstract

In seven women and two men with Parkinson's disease, Hoehn and Yahr stage 1 or 2, the effect of repetitive transcranial magnetic stimulation (rTMS) was evaluated. Primary endpoint outcome measure was the changing of the motor items of the Unified Parkinson's Disease Rating Scale (subscale III of UP-DRS) 24 h after stimulation. Kinesiologic tests and writing samples were secondary outcome measures. After discontinuing all medication, stimulation was performed with 5 Hz at 90% of the motor threshold over the primary motor cortex of the more affected. There were 2250 stimuli applied, divided into 15 trains at intervals of 10 s. The identical treatment of the opposite side served as control treatment. Only treatment of the more affected side resulted in a significant improvement of the clinical symptoms of 46% as assessed by the UPDRS (p < 0.02). This effectiveness differed significantly from the control treatment (21%, p < 0.02). The kinesiological testing did not show any significant speeding of movements (p > 0.05). Some patients showed a normalisation of the previously disturbed handwriting specimen. These data confirm the previous observation that rTMS of primary motor regions leads to at least temporary clinical improvement of symptoms in patients with Parkinson's disease.

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

“…The behavior of the current density distribution directly under the coil center was very similar to the analogous atrophy models, but far less predictable along the widened sulci borders, similar to the results seen in stroke (Wagner 2001;Wagner et al 2005) and heterogeneity studies (Wagner 2001;Miranda et al 2003). There were locations directly below the most posterior portion of the figure-of-eight coil, along the widened central sulci border, where current density magnitudes were within ±15% of the maximums found under the coil center (3.59, −0.85, 6.61, and 14.35%, respectively for the base, 95, 90, and 85% widened sulci models).…”

“…These will obviously depend on the geometry and electrical tissue distributions in the regions of the sulci, but earlier studies have clearly shown the effects of heterogeneities, as those operating at sulcal borders, can be extremely significant (Wagner 2001: Wagner et al 2004, 2005Miranda et al 2003). As is supported by studies examining corner points in other electromagnetic models (Deeley 1990), we hypothesize that the effects will be most extensive at regions where the border geometries result in corner regions, such as could be seen along irregular edges of scar tissue along an infarction border.…”

“…With TMS, changes in the tissue anatomy and electromagnetic properties have been shown to alter the TMS induced stimulating currents in both phantom and modeling studies (Yunokuchi et al 1998) (Liu and Ueno 2000;Wagner 2001;Miranda et al 2003;Wagner et al 2004). We have shown previously that the damaged areas in patients with stroke can perturb the location and magnitude of the stimulating cortical currents .…”

“…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

“…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. Most studies, especially those targeting M1, SMA and DLPFC, administered high-frequency stimulation (24 of 40 studies) [29][30][31][32][33][34][37][38][40][41][42][43][44][49][50][51][53][54][55][57][58][60][61][62], while lowfrequency stimulation was employed primarily in studies targeting other regions. The intensity of stimulation ranged from 20% of motor threshold to 120%.…”