Abstract
There are no effective treatments in progressive supranuclear palsy (PSP). The aim of this study was to test the efficacy of theta burst repetitive transcranial magnetic stimulation (rTMS) on postural instability in PSP. Twenty PSP patients underwent a session of sham or real cerebellar rTMS in a crossover design. Before and after stimulation, static balance was evaluated with instrumented (lower back accelerometer, Rehagait®, Hasomed, Germany) 30-s trials in semitandem and tandem positions. In tandem and semitandem tasks, active stimulation was associated with increase in time without falls (both p=0.04). In the same tasks, device-extracted parameters revealed significant improvement in area (p=0.007), velocity (p=0.005), acceleration and jerkiness of sway (p=0.008) in real versus sham stimulation. Cerebellar rTMS showed a significant effect on stability in PSP patients, when assessed with mobile digital technology, in a double-blind design. These results should motivate larger and longer trials using non-invasive brain stimulation for PSP patients.
Highlights
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterised by akinetic rigid syndrome with ocular motor dysfunction, early postural instability and falls [1].Despite potential limited benefit from dopaminergic drugs, there are still no effective treatments available for postural instability and falls
A preliminary, open-label trial with 10 PSP patients showed an improvement of CBI using theta burst repetitive cerebellar transcranial magnetic stimulation [7]
All patients presented with postural instability, as reflected by specific PSP rating scale (PSPRS) items and Tinetti scale
Summary
Progressive supranuclear palsy (PSP) is a neurodegenerative disorder characterised by akinetic rigid syndrome with ocular motor dysfunction, early postural instability and falls [1].Despite potential limited benefit from dopaminergic drugs, there are still no effective treatments available for postural instability and falls. Recent imaging and neuropathology studies revealed a reduced volume of the cerebellum with Tau accumulation in PSP patients [2, 3]. These evidences suggest that cerebellum may be a potential target for non-invasive stimulation, as already recently demonstrated for multiple sclerosis [4]. A preliminary, open-label trial with 10 PSP patients showed an improvement of CBI using theta burst repetitive cerebellar transcranial magnetic stimulation (rTMS) [7]. A case study showed improvement of posturography parameters secondary to cerebellar stimulation in two PSP patients [8]
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