The effect of intensive physical therapy with repetitive transcranial magnetic stimulation in patients with degenerative cerebellar disease

Abstract

The studies of repetitive transcranial magnetic stimulation (rTMS) of the brain have demonstrated the modulation of cortical excitability. Combination of rTMS with physical therapy (PT) might affect the therapeutic effects for movement disorders. The aim of this study was to investigate the effect of combination of intensive PT with rTMS in patients with degenerative cerebellar disease. Twelve patients with degenerative cerebellar disease participated in the study. The rTMS and PT were carried out five days a week for three weeks. The gait parameters were determined using a three-dimensional motion analysis system, and the total length and the velocity of the center of pressure (COP) in standing position using a stabilometer and the International Cooperative Ataxia Rating Scale (ICARS) were assessed in all patients before and after the intervention. The changes in the walking speed, step width, the total length of the COP and the velocity of the COP in standing position were not significant. The amplitude of the lateral head and body sway when walking were reduced after intervention ( P < 0.01) and the ICARS was improved after the intervention ( P < 0.01). The correlations between the duration of disease and the improvement of walking speed and step width were not significant. The correlations between the disease severity and the improvement of walking speed and step width were significant. In our study, combination of intensive PT and rTMS conferred positive effects on the dynamic balance in patients with degenerative cerebellar disease in earlier stages of the disease.