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Abstract
Objective: To explore the efficacy and stimulation frequency dependence of repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) in Parkinson disease (PD).
Methods: In this randomized, double-blind, sham-controlled, multicenter study with a parallel design, a weekly intervention was performed 8 times. The effects were monitored up to 20 weeks. By central registration, participants were assigned to 1 of 3 arms of the study: low-frequency (1-Hz) rTMS, high-frequency (10-Hz) rTMS, and realistic sham stimulation. The primary end point was the score change of the Unified Parkinson's Disease Rating Scale (UPDRS) part III from the baseline. Several nonmotor symptom scales such as the Hamilton Rating Scale for Depression, apathy score, and nonmotor symptoms questionnaire were defined as secondary end points.
Results: Of the 106 patients enrolled, 36 were allocated to 1-Hz rTMS, 34 to 10-Hz rTMS, and 36 to realistic sham stimulation. Results show 6.84-point improvement of the UPDRS part III in the 1-Hz group at the last visit of the 20th week. Sham stimulation and 10-Hz rTMS improved motor symptoms transiently, but their effects disappeared in the observation period. Changes in nonmotor symptoms were not clear in any group. No severe adverse event was reported.
Conclusions: The 1-Hz rTMS over the SMA was effective for motor, but not nonmotor, symptoms in PD.
Level of evidence: This study provides Class I evidence that 1-Hz rTMS over the SMA is effective for motor symptoms in PD.
GLOSSARY
- ANOVA=
- analysis of variance;
- CI=
- confidence interval;
- DBS=
- deep brain stimulation;
- NMS=
- nonmotor symptoms;
- PD=
- Parkinson disease;
- rTMS=
- repetitive transcranial magnetic stimulation;
- SMA=
- supplementary motor area;
- STN=
- subthalamic nucleus;
- UPDRS=
- Unified Parkinson's Disease Rating Scale
Footnotes
Research Committee on rTMS Treatment of Parkinson's Disease coinvestigators are listed on the Neurology® Web site at www.neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at www.neurology.org
- Received August 28, 2012.
- Accepted in final form January 3, 2013.
- © 2013 American Academy of Neurology
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