Abstract
Introduction The sequence effect (SE) is a reason contributing to freezing of gait (FOG) in Parkinson's disease (PD) patients. There is no effective treatment for the SE. The objective of the current study is to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the SE in PD patients with FOG. Methods 28 PD patients with FOG received either real or sham 10-Hz rTMS over the supplementary motor area (SMA). The effects of rTMS on the SE, FOG, and some gait parameters were evaluated. Results rTMS did not improve the SE. Real rTMS had beneficial effects on FOG and some gait parameters, and this effect lasted for at least four weeks. Conclusions High-frequency rTMS over the SMA cannot alleviate the SE in PD patients with FOG. rTMS has a long-lasting beneficial effect on FOG; however, this effect is not achieved by improving the SE but may be through improving some other gait parameters.
Highlights
Freezing of gait (FOG) is a disabling and common symptom in Parkinson’s disease (PD) characterized by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking [1, 2].e mechanisms underlying FOG are poorly understood
High-frequency repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) cannot alleviate the sequence effect (SE) in PD patients with FOG. rTMS has a long-lasting beneficial effect on FOG; this effect is not achieved by improving the SE but may be through improving some other gait parameters
Nieuwboer et al [7] suggested that freezing whilst walking could stem from stride-to-stride variability, which results in failure to generate normal amplitude in step length, comparing with those that do not experience freezing [8, 9]. is magnitude of stride-to-stride fluctuations further increase in patients in the “off” state [3, 8, 10], hastening, or an increase in cadence with a decrease in step length, often deteriorate FOG [7]
Summary
Freezing of gait (FOG) is a disabling and common symptom in Parkinson’s disease (PD) characterized by brief episodes of inability to step or by extremely short steps that typically occur on initiating gait or on turning while walking [1, 2]. Is magnitude of stride-to-stride fluctuations further increase in patients in the “off” state [3, 8, 10], hastening, or an increase in cadence with a decrease in step length, often deteriorate FOG [7]. In PD patients, the decreased amplitudes might further destabilize normal gaits and induce a vicious circle of progressively shorter step length, resulting in FOG [7]. Despite the discrepant results [12,13,14,15], there are increasing studies that have reported benefit effects of rTMS on FOG [16]. We investigated the potential benefits of rTMS on the SE in PD patients with FOG in the current study
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