Long Term Follow-Up Study with non-invasive brain stimulation (NBS) (rTMS and tDCS) in Parkinson’s disease (PD). Strong Age Dependency in the Effect of NBS

Abstract

Background: Transcranial magnetic stimulation (rTMS) may influence the progression of PD compared with levodopa. The long term mind modification effect of repeated rTMS and tDCS is not known, nor are the predictors for the effect of NBS. Objective/hypothesis: We hypothesized that the regularly repeated rTMS would decrease the development of PD. Later, the treatment protocol was completed with transcranial direct current stimulation (tDCS), supposing that there is an add-on effect. NBS may differently influence motor and mental aspects of the disease. Methods: Thirty patients with PD were followed for 3.5 years in an open study. They were stimulated with 1 Hz rTMS every half year for 1.5 years. After that the tDCS was add to the stimulation over both sides of the cerebellum for the next 2 years. UPDRS, Trail Making Test and dual tests were used. The linear regression lines of score systems and percentage of yearly increment were counted, analyzed by ANOVA. Results: The yearly progression rate for UPDRS total was 2% for 3.5 years, 0.6% ≤65 years, 3.6% > 65 years. The increment was around zero during the rTMS + tDCS stimulations in patients ≤65 years. The slope of the equation showed the same tendency. The individual sensitivity to the NBS was high. tTMS and tDCS > 65 yrs improved pathological executive function (p < 0.0001). Conclusion: The motor ability in PD was maintained at the same level in patients ≤65 years with NBS for the 3.5 years in contrast to patients > 65 years. The cognitive function of patients > 65 yrs was favorable influenced by rTMS and tDCS. Age is the main predictor of the effect of NBS. rTMS and tDCS can slow the progression of PD without any side effects but in an age-dependent way.

Multisite non-invasive brain stimulation in Parkinson’s disease: A scoping review

“…A large majority of the studies presented describe the most relevant characteristics for the characterization of participants in the baseline, however, they do not address how they could interfere in the interpretation of the results. A long-term follow-up study (Málly et al, 2018) of the use of NIBS (rTMS and tDCS), showed that the therapy is able to slow the progression of the disease, but that age is the main predictor of its effect. In other clinical populations such as stroke, these predictors of response may be related to the severity of symptoms, the size and location of the lesions, the etiology of the stroke and the time from symptom onset to intervention (Ovadia-Caro et al, 2019).…”

Effects of a single session of cathodal transcranial direct current stimulation primed intermittent theta-burst stimulation on heart rate variability and cortical excitability measures

“…This combinatory approach has been proved to be more effective than either protocol alone in achieving optimal motor cortical plasticity based on metaplasticity effects, [4] as well as in driving clinical gains. [5][6][7] Further, studies have demonstrated that autonomic cardiovascular control through modulation of neurocardiac regulation could be influenced by electrical or magnetic stimulation. [8,9] While the motor cortical and clinical effects of dual stimulation are evident, [5][6][7] its effect on neurocardiac regulation which might be related to changes in excitability measures has not been well studied.…”

“…[5][6][7] Further, studies have demonstrated that autonomic cardiovascular control through modulation of neurocardiac regulation could be influenced by electrical or magnetic stimulation. [8,9] While the motor cortical and clinical effects of dual stimulation are evident, [5][6][7] its effect on neurocardiac regulation which might be related to changes in excitability measures has not been well studied. We designed the current study with objectives of investigating the effects of priming rTMS with tDCS on cardiac autonomic control as assessed by heart rate variability (HRV) and motor cortical excitability measures using TMS.…”