Therapeutic and “dose-dependent” effect of repetitive microelectroshock induced by transcranial magnetic stimulation in Parkinson's disease

Abstract

Transcranial magnetic stimulation (TMS) has been used in the diagnosis of neurological lesions and has been introduced into the therapy of central nervous diseases. Lately it has been claimed that TMS would be useful not only in the treatment of depression, but also in relieving symptoms of Parkinson's disease. In this study, we sought evidence of the effect of repetitive TMS on the symptoms of Parkinson's disease, the dose dependency between the applied elecromagnetic field and the Parkinsonian symptoms, and the maintenance of the improvement. Forty-nine patients with Parkinson's disease were divided into four groups, each given one stimulus, repeated 30 times, once or twice a day ( approximately 0.34Tesla (T), approximately 0.57T, approximately 0.80T). Patients were followed for 3 months and assessed using two different parkinsonian scales: the graded clinical rating scale and Unified Parkinson Disability Rating Scale (UPDRS), and with a short-term memory test (Ziehen-Ranschburg word pair test). No effect was seen in the group treated with approximately 0.34T\30 stimuli once a day. In all of the groups receiving TMS twice a day, the parkinsonian scores were significantly decreased compared with that of baselines after 1 month of treatment. The greatest improvement in the hypokinesia was detected in the group treated with approximately 0.57T\30 stimuli twice a day (baseline total UPDRS: 30.62 +/- 15.23; 1 month after treatment: 17.08 +/- 7.04, P < 0.01; 3 months after treatment: 16.08 +/- 7.06, P < 0.01). A dose-dependent difference was observed between the two groups after 3 months. The total UPDRS in Group II ( approximately 0.34T\30 stimuli twice a day) significantly differed from Group III ( approximately 0.57T\30 stimuli twice a day; 22.43 +/- 8.87, 16.08 +/- 7.06, P < 0.05). The long-lasting improvement effect with TMS would seem to suggest it as an appropriate tool in the therapy of Parkinson's disease.

Transcranial magnetic brain stimulation: Therapeutic promises and scientific gaps

“…Others (Ghabra, et al, 1999), however, could not replicate this finding. Mally and coworkers (Mally & Stone, 1999) were the first to report a lasting beneficial effect of “offline” TMS in PD patients. In an open trial, they delivered 30, single TMS pulses, at a range of very moderate intensities, either once or twice a day, for 7–10 days.…”

0.2‐Hz repetitive transcranial magnetic stimulation has no add‐on effects as compared to a realistic sham stimulation in Parkinson's disease

“…Pascual‐Leone and colleagues1 first applied repetitive transcranial magnetic stimulation (rTMS) to the treatment of Parkinson's disease (PD). Later reports2–11 have used rTMS as a potential therapeutic tool for PD and some of them1–8 showed a therapeutic effect, whereas others found no significant effects 9–11. In one study, rTMS over supplementary motor area (SMA) worsened motor performance 11.…”

“…In most of these studies, a short‐term effect (duration <1 hour) has been studied. In three studies,2–4 however, long‐lasting beneficial effects (a few days to a week) have been evoked by low frequency rTMS although such low frequency rTMS was reported to have no after effects on the motor cortex 14. Moreover, it has been reported recently that ataxia was also improved by low frequency rTMS (<0.2 Hz) over the cerebellum in patients with degenerative ataxia 15.…”

Immediate Effects of Repetitive Magnetic Stimulation on Single Cortical Pyramidal Neurons

“…Transcranial Magnetic Stimulation (TMS) is a non-invasive method of neural activation, currently used as a therapeutic intervention in neurological disorders like depression [1, 2], and migraine [3]; and being investigated for clinical applications in epilepsy [4, 5], movement disorders [6], stroke [7, 8], brain injury [9], and schizophrenia [10, 11]. It is also frequently used as an investigative tool for basic neuroscience [12–17].…”