Repetitive Transcranial Magnetic Stimulation in Treatment of Levodopa-Induced Dyskinesia in Parkinson’s Disease

Abstract

Background: Dyskinesia is one of the major complications of longterm dopaminergic treatment of Parkinson's disease (PD), and deep brain stimulation may be the only satisfactory treatment for it. This study aims to search if there is any therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) for levodopa-induced dyskinesia (LID) in PD patients.Methods: This study was conducted in Mansoura International Specialized Hospital in 43 complicated idiopathic PD patients. The patients with LID were divided into two groups matched in age, sex, duration and stage of the disease. Dyskinesia was detected by the Unified PD Rating Scale section IV. The patients of the study group (20 patients) received active rTMS, 5 Hz was applied bilaterally over the motor hand and leg areas of the cortex, in 20 trains, and each train is formed of 100 pulses, with 20-s inter-train interval. Ten sessions were administered once per day for 10 successive days for each patient. The patients of the control group (20 patients) received sham rTMS.Results: After rTMS, there was significant improvement in LID in the study group (P < 0.001), while there was no improvement in the control one (P = 0.585). As regards to the LID clinical presentations, there was no significant difference between the two groups according to dyskinesia duration (P = 0.246), disability (P = 0.425) and early morning dystonia (P = 0.059), while there was significant improvement of painful dyskinesia in the study group (P = 0.046). Conclusions:The rTMS may have an additional therapeutic benefit for LID. Further studies may put the best rTMS parameters to establish more prominent and longer-lasting clinical effects.

Electrical stimulation methods and protocols for the treatment of traumatic brain injury: a critical review of preclinical research

“…The therapeutic potential of rTMS is widely recognized, particularly in the field of psychiatry, and it is applied as a treatment option for depression [ 87 , 88 ] and obsessive–compulsive disorder [ 89 , 90 ]. Its efficacy was further tested as a treatment for a number of different neurological conditions, such as neuropathic pain [ 91 , 92 ], epilepsy [ 93 ], stroke [ 94 ], multiple sclerosis [ 95 ] and post-traumatic stress disorder [ 96 ], as well as Parkinsonian movement disorders [ 97 , 98 ].…”

Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases

“…In these patients, favorable targets for high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) include primary motor cortex (M1), less focal motor cortex (MC) stimulation such as to leg or bilateral hand MC, and dorsolateral prefrontal cortex (DLPFC), while supplementary motor area (SMA) was found to be the most favorable low-frequency repetitive transcranial magnetic stimulation (LF-rTMS target) ( 8 , 13 , 70 ). rTMS to these targets has also been found effective for levodopa-induced dyskinesia (LID) ( 37 ). However, Lefaucheur ( 24 ) felt that these benefits were sometimes the results of a single session, and the prolonged clinical benefit needs to be investigated.…”