Effects of a Single Session of Repetitive Transcranial Stimulation in Parkinson Disease

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique proposed for recovery of gait and balance in patients with Parkinson's disease (PD). Our aim was to evaluate the effects of rTMS in PD patients by clinical evaluation and computerized gait analysis. Ten patients were recruited. Each patient was assessed before and after a single session of rTMS by: Berg Scale, Unified Parkinson Disease Rating Scale (UPDRS), 6 Minute Walking Test (6MWT), 10MWT, Time Up and Go (TUG) and spatial-temporal gait analysis by Pablo Gait Assessment sensor. We availed of STM 9000, stimulating with 2000 pulses of 20 Hz rTMS, delivered in 5-second trains with 25 seconds between trains, on the hand area of the motor cortex at 90% resting motor threshold (RMT) on each hemisphere, with 5 minutes pause between hemispheres. Eighty percent of the patient reported subjective benefits, corroborated by objective examination of the results. A significant improvement on the Berg scale was observed. Moreover, a tendence to a significant decrease of stiffness at the lower limbs was evident at UPDRS. Gait analysis showed not significant improvements of evaluated parameters. Although it is premature to draw conclusions, because of the small number of patients, underwent to a single session of rTMS, we confirm the possible beneficial effects and the safety of rTMS. Further studies are needed to validate our findings by clinical evaluation and gait analysis at short, medium, and long term. These may be different in relation to the age, duration and stage of the disease, prevalence of tremor or akinesia and rigidity.