Introduction: Dopamine replacement medications are an effective current medical management of
Parkinson disease (PD), particularly for motor symptoms but later, the response declines and complications
develop. The efficacy of Transcranial magnetic stimulation (TMS) on motor cortex in Parkinson disease is
debatable since studies have shown conflicting results. The most common adverse events are transient
headaches and scalp discomfort. The aim of this work is to evaluate rTMS high frequency (15 Hz) impact on
the motor functions in PD patients. Patients and Methods: 43 patients with PD (15 females and 28
males) aged between 51 and 76 years (mean 64 ± 8.2 years) were included in our study. Randomly, 31 patients
were assigned to either of these two groups; Group I (16) patients on anti-parkinsonian medications only and
group II (15) patients on antiparkinsonian medications and TMS. Group III (12) patients were chosen from
those patient still not on medicine or stop it. 15 Hz stimulation was delivered with an intensity of 10% above
the motor threshold (MT) for 10 daily sessions. Each session included the delivery of 75 stimuli for 5 sec
interval then followed by a 10 sec interval. The daily total of trains and the daily number of pulses were 40
trains and 3000 pulses, respectively. The assessment before and immediately after TMS sessions included a
clinical evaluation through the Unified Parkinson’s Disease Rating Scale (UPDRS) and in specific part III
motor section, Schwab and England and Hoehn and Yahr scales. Reevaluation was performed after1 months.
Results: In the present study there is significant difference (improvement) in groups II and III resulting from,
between base line and immediately after rTMS course also, between base line and 1 month after rTMS. There
was a slight decrease (not significant) in score at 1 month after the rTMS in correlation to immediately after it.
In group I the difference between base line compared to after antiparkinsonian medications and 1 month after it
were significant. The comparison between (Group I vs. Group II), revealed a statistically significant difference
(improvement) between base line and after the treatment, also after 1 month. But the comparison between
(Group III vs. Group I), revealed a statistically no significant difference, between base line and immediately
after, and also, 1 month after rTMS. The there was no significance in the difference between directly after
treatment and one month later in both Group II and group III. Conclusion: This study showed that motor
symptoms in PD patients can be now treated by high-frequency TMS. Farther studies are needed in this field to
understand the impact of TMS on PD's different stages, the effect of TMS on various aspects of the disease
(cognition, memory, etc.), and also to optimize the stimulation parameters.
Introduction
Parkinson’s disease (PD) is a progressive,
neurodegenerative disease that has a fast early phase
progress but slower progression in the later stages¹.
Advances since the 1960s have mechanisms as
contributing to the pathophysiology of movement disorders,
such as depletion of neurotransmitters (e.g., dopamine),
changes in the basal ganglia and cortical targets connecting
loops, and abnormal cortical plasticity².
*Corresponding author: Osama E. El Dib
Department of Neurology, Menofiya University
Based on the concepts involved, a wide range of current
treatment options have been developed, including
medications, botulinum toxin, and deep brain stimulation
(DBS)3,4 . However, these current therapies are limited
despite the achieved advances. Dopamine replacement
medications are considered the current major medical
treatment to manage motor symptoms in PD, but later, the
response declines and complications develop.6 Although
DBS procedures in PD can treat medication-induced motor
fluctuations in selected patients, there has been increasing
recognition of cognitive and mood side effects of DBS, in
addition to risks attendant with invasive surgical options but
provoke more impairment in voluntary movements
(dyskinesia) in two-year follow-up interval.7
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