Retrospective evaluation of deep transcranial magnetic stimulation as add-on treatment for Parkinson’s disease

Journal: Frontiers in Neurology 6:210 (2015)

Authors: F Torres, E Villalon, P Poblete, R Moraga-Amaro, S Linsambarth, R Riquelme, A Zangen, J Stehberg

Background:

Parkinson’s disease (PD) is a chronic, progressive disorder for which there is no satisfactory long-term treatment.Focal neuromodulation with repetitive transcranial magnetic stimulation (rTMS) has raised increased interest over the past few years as a promising coadjuvant treatment for many neurological and psychiatric disorders, including PD, as it induces changes in cortical excitability non-invasively that persist after stimulation, with cumulative effects over time.

Objective:

To evaluate the safety and assess the different symptom improvements found after a combined low-frequency primary motor cortex and high-frequency prefrontal cortex (PFC) stimulation using the deep TMS (dTMS) H-coil, as an add-on treatment for Parkinson’s disease (PD).

Methods:

Forty-five PD patients underwent 14 dTMS sessions; each consisting of 1 Hz stimulation of the primary motor cortex for 15 min, followed by 10 Hz stimulation of the PFC for 15 min. Clinical assessments were performed, BEFORE, at the MIDDLE, and END of therapy as well as at FOLLOW-UP after 30 days, using Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, TINETTI, UP&GO, SCOPA, HDRS21, Beck Depression Inventory, and self-applied daily motor assessment scales.

Results:

Treatment was well-tolerated, without serious adverse effects. dTMS-induced significant PD symptom improvements at END and at FOLLOW-UP, in all subscales of the UPDRS, gait speed, depressive symptoms, balance, autonomic symptoms, and a 73% increase in daily ON time.

Conclusions:

The dTMS-induced significant improvements in motor, postural, and motivational symptoms of PD patients and may potentiate concurrent levodopa treatment.This study demonstratedthat dTMS may have a much wider spectrum of beneficial effects than previously reported for TMS, including enhancement of levodopa effects, suggesting that future clinical trials with dTMS should include a broader range of symptom measurements.

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