Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a promising therapeutic tool for Parkinson's disease (PD), and many stimulation targets have been implicated. We aim to explore whether low-frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) improves motor and nonmotor symptoms of individuals with PD. Methods We conducted a randomized, single-blind, sham-controlled parallel trial to compare the effect of 10 consecutive daily sessions of 1 Hz rTMS over right DLPFC on individuals with idiopathic PD between active and sham rTMS group. Primary outcomes were changes in Unified Parkinson's Disease Rating Scale (UPDRS) part III and Nonmotor Symptom Questionnaire (NMSQ). Secondary outcomes were changes in UPDRS total score, Hamilton Rating Scale for Depression (HRSD), Pittsburgh Sleep Quality Index (PSQI), and Montreal Cognitive Assessment (MoCA). Assessments were completed at baseline, after treatment, and at 1 month, 3 months, and 6 months after treatment. Results A total of 33 participants with PD were randomized. All participants completed the study and no severe adverse effect was noticed. Compared to baseline, active rTMS showed significant improvements in UPDRS part III and NMSQ at 1 month. Change of scores on UPDRS part III, HRSD, and PSQI persisted for 3 months after rTMS intervention. The beneficial effect on cognitive performance assessed by MoCA was maintained for at least 6 months in the follow-up. No significant changes were observed in the group with sham rTMS. Conclusions Low-frequency rTMS of right DLPFC could be a potential selection in managing motor and nonmotor symptoms in PD.
Highlights
Parkinson’s disease (PD) is a second common neurodegenerative disease characterized by cardinal motor symptoms as bradykinesia, resting tremor, rigidity, and postural instability and gait disorders [1]
No severe adverse events were noticed. In this single-blind, sham-controlled, randomized trial, we reported that a 10-day consecutive 1 Hz Repetitive transcranial magnetic stimulation (rTMS) over right dorsolateral prefrontal cortex (DLPFC) promoted motor and several nonmotor symptoms among individuals with PD
Neuroimaging studies revealed that hypoactivated left DLPFC was mainly associated with mood changes in PD [7]
Summary
Parkinson’s disease (PD) is a second common neurodegenerative disease characterized by cardinal motor symptoms as bradykinesia, resting tremor, rigidity, and postural instability and gait disorders [1]. Repetitive transcranial magnetic stimulation (rTMS) is a promising noninvasive brain modulation technique in improving motor and nonmotor symptoms of PD in addition to pharmacological treatment [3, 4]. We aim to explore whether low-frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) improves motor and nonmotor symptoms of individuals with PD. Primary outcomes were changes in Unified Parkinson’s Disease Rating Scale (UPDRS) part III and Nonmotor Symptom Questionnaire (NMSQ). Secondary outcomes were changes in UPDRS total score, Hamilton Rating Scale for Depression (HRSD), Pittsburgh Sleep Quality Index (PSQI), and Montreal Cognitive Assessment (MoCA). Active rTMS showed significant improvements in UPDRS part III and NMSQ at 1 month.
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