Abstract
Repetitive transcranial magnetic stimulation (rTMS) is a safe and painless method for stimulating cortical neurons. In neurological realm, rTMS has prevalently been applied to understand pathophysiological mechanisms underlying movement disorders. However, this tool has also the potential to be translated into a clinically applicable therapeutic use. Several available studies supported this hypothesis, but differences in protocols, clinical enrollment, and variability of rTMS effects across individuals complicate better understanding of efficient clinical protocols. The aim of this present review is to discuss to what extent the evidence provided by the therapeutic use of rTMS may be generalized. In particular, we attempted to define optimal cortical regions and stimulation protocols that have been demonstrated to maximize the effectiveness seen in the actual literature for the three most prevalent hyperkinetic movement disorders: Parkinson's disease (PD) with levodopa-induced dyskinesias (LIDs), essential tremor (ET) and dystonia. A total of 28 rTMS studies met our search criteria. Despite clinical and methodological differences, overall these studies demonstrated that therapeutic applications of rTMS to “normalize” pathologically decreased or increased levels of cortical activity have given moderate progress in patient's quality of life. Moreover, the present literature suggests that altered pathophysiology in hyperkinetic movement disorders establishes motor, premotor or cerebellar structures as candidate regions to reset cortico-subcortical pathways back to normal. Although rTMS has the potential to become a powerful tool for ameliorating the clinical outcome of hyperkinetic neurological patients, until now there is not a clear consensus on optimal protocols for these motor disorders. Well-controlled multicenter randomized clinical trials with high numbers of patients are urgently required.
Highlights
Alteration in dynamics of neural connectivity is the hallmark of motor and behavioral disease in humans
The present review aims to focus on studies using transcranial brain stimulation protocols to modulate hyperkinetic neurological disorders aimed at clarifying the optimal conditions in which non-invasive stimulation may be used in movement disorders
We summarize key technical aspects of Repetitive transcranial magnetic stimulation (rTMS) with effective results for Parkinson’s disease (PD), essential tremor (ET), and dystonia to propose focused research plans to increase the positive impact of non-invasive brain stimulation in clinical practice
Summary
Alteration in dynamics of neural connectivity is the hallmark of motor and behavioral disease in humans. The rationale behind the choice to stimulate SMA is based either on previous neuroimaging findings describing functional overactivity in this region (Rascol et al, 1998; Brooks et al, 2000) or on the notion that repeated sessions of premotor cortex stimulation induces cumulative changes in the excitability over the primary motor cortex (Bäumer et al, 2003) With this in mind, Brusa et al (2006) tried to translate this single TMS protocol in a prolonged therapeutic session (5 days), failing to demonstrate a clear beneficial effect. Idiopathic PD is primarily a disorder of response initiation characterized by an excessive motor inhibition (i.e., akinesia, bradykinesia), rTMS Application in Movement Disorders
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