Repetitive transcranial magnetic stimulation of the primary motor cortex in the treatment of motor signs in Parkinson's disease: A quantitative review of the literature

Zanjani, Anosha; Zakzanis, Konstantine K.; Daskalakis, Zafiris J.; Chen, Robert

doi:10.1002/mds.26206

Cited by 65 publications

(44 citation statements)

References 33 publications

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“…The magnitude of the improvement (24.9 points in the UPDRS-III) was equal to a minimal clinically important change on the UPDRS-III 20 but slightly below that found in recent meta-analyses (26.4 and 26.3 points 7,21 ). We believe that the lower magnitude of improvement seen here is most likely secondary to the use of realistic sham (which might have mitigated expectations and improved blinding) and to smaller sample sizes in other studies.…”

Section: Duration Of Treatment Participants Received Real or Sham Rtmscontrasting

confidence: 60%

Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease

et al. 2016

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Objective: To assess whether multifocal, high-frequency repetitive transcranial magnetic stimulation (rTMS) of motor and prefrontal cortex benefits motor and mood symptoms in patients with Parkinson disease (PD). Methods:Patients with PD and depression were enrolled in this multicenter, double-blind, shamcontrolled, parallel-group study of real or realistic (electric) sham rTMS. Patients were randomized to 1 of 4 groups: bilateral M1 ( 1 sham dorsolateral prefrontal cortex [DLPFC]), DLPFC ( 1 sham M1), M1 1 DLPFC, or double sham. The TMS course consisted of 10 daily sessions of 2,000 stimuli for the left DLPFC and 1,000 stimuli for each M1 (50 3 4-second trains of 40 stimuli at 10 Hz). Patients were evaluated at baseline, at 1 week, and at 1, 3, and 6 months after treatment. Primary endpoints were changes in motor function assessed with the Unified Parkinson's Disease Rating Scale-III and in mood with the Hamilton Depression Rating Scale at 1 month.Results: Of the 160 patients planned for recruitment, 85 were screened, 61 were randomized, and 50 completed all study visits. Real M1 rTMS resulted in greater improvement in motor function than sham at the primary endpoint (p , 0.05). There was no improvement in mood in the DLPFC group compared to the double-sham group, as well as no benefit to combining M1 and DLPFC stimulation for either motor or mood symptoms. Conclusions:In patients with PD with depression, M1 rTMS is an effective treatment of motor symptoms, while mood benefit after 2 weeks of DLPFC rTMS is not better than sham. Targeting both M1 and DLPFC in each rTMS session showed no evidence of synergistic effects. Parkinson disease (PD) presents with both motor and nonmotor features. Motor symptoms can respond to pharmacologic and other therapies such as deep brain stimulation, 1 but these treatments are often ineffective for nonmotor symptoms. Depression is particularly common, with a prevalence ranging from 40% to 70%.2 Not infrequently, depression in PD is resistant to medication and affects patients' quality of life.

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Section: Duration Of Treatment Participants Received Real or Sham Rtmscontrasting

confidence: 60%

Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease

et al. 2016

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“…Further experimental data is needed, but the success of transcranial magnetic stimulation and repetitive transcranial magnetic stimulation in relieving symptoms, admittedly only short term and susceptible to placebo effect, is encouraging [71]. Similarly, and perhaps more consistent with our thesis, was the evidence of recovery in monkeys made parkinsonian with MPTP injection after stimulation via an electrode over the dura in the motor sulcus [26] and reassuring, are the efforts to stimulate motor cortex in patients with extradural electrodes [9].…”

Section: Optimistic Perspectivesupporting

confidence: 58%

Are the Symptoms of Parkinsonism Cortical in Origin?

Arbuthnott¹,

García‐Muñoz²

2017

Computational and Structural Biotechnology Journal

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We present three reasons to suspect that the major deleterious consequence of dopamine loss from the striatum is a cortical malfunction. We suggest that it is cortex, rather than striatum, that should be considered as the source of the debilitating symptoms of Parkinson's disease (PD) since:Cortical synapses onto striatal dendritic spines are lost in PD.All known treatments of the symptoms of PD disrupt beta oscillations. Oscillations that are also disrupted following antidromic activation of cortical neurons.The final output of basal ganglia directly modulates thalamic connections to layer I of frontal cortical areas, regions intimately associated with motor behaviour.These three reasons combined with evidence that the current summary diagram of the basal ganglia involvement in PD is imprecise at best, suggest that a re-orientation of the treatment strategies towards cortical, rather than striatal malfunction, is overdue.

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“…However, this circuit can be perturbed by NIBS. rTMS is capable to briefly alleviate PD motor symptoms (Zanjani et al, 2015). One possibility is that rTMS could disrupt the excessive beta activity that is characteristic of cortico-subcortical motor network activity in PD patients, similarly to what is supposed to be the mechanism of action of STN DBS.…”

Section: Nibs Modulation Of Oscillatory Activitiesmentioning

confidence: 99%

Oscillatory Activities in Neurological Disorders of Elderly: Biomarkers to Target for Neuromodulation

Assenza

Capone

Biase

et al. 2017

Front. Aging Neurosci.

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Non-invasive brain stimulation (NIBS) has been under investigation as adjunct treatment of various neurological disorders with variable success. One challenge is the limited knowledge on what would be effective neuronal targets for an intervention, combined with limited knowledge on the neuronal mechanisms of NIBS. Motivated on the one hand by recent evidence that oscillatory activities in neural systems play a role in orchestrating brain functions and dysfunctions, in particular those of neurological disorders specific of elderly patients, and on the other hand that NIBS techniques may be used to interact with these brain oscillations in a controlled way, we here explore the potential of modulating brain oscillations as an effective strategy for clinical NIBS interventions. We first review the evidence for abnormal oscillatory profiles to be associated with a range of neurological disorders of elderly (e.g., Parkinson’s disease (PD), Alzheimer’s disease (AD), stroke, epilepsy), and for these signals of abnormal network activity to normalize with treatment, and/or to be predictive of disease progression or recovery. We then ask the question to what extent existing NIBS protocols have been tailored to interact with these oscillations and possibly associated dysfunctions. Our review shows that, despite evidence for both reliable neurophysiological markers of specific oscillatory dis-functionalities in neurological disorders and NIBS protocols potentially able to interact with them, there are few applications of NIBS aiming to explore clinical outcomes of this interaction. Our review article aims to point out oscillatory markers of neurological, which are also suitable targets for modification by NIBS, in order to facilitate in future studies the matching of technical application to clinical targets.

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Repetitive transcranial magnetic stimulation of the primary motor cortex in the treatment of motor signs in Parkinson's disease: A quantitative review of the literature

Cited by 65 publications

References 33 publications

Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease

Multifocal repetitive TMS for motor and mood symptoms of Parkinson disease

Are the Symptoms of Parkinsonism Cortical in Origin?

Oscillatory Activities in Neurological Disorders of Elderly: Biomarkers to Target for Neuromodulation

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