Controlled trial on the effect of 10 days low-frequency repetitive transcranial magnetic stimulation (rTMS) on motor signs in Parkinson´s disease

摘要

[Abstract] We evaluated the effect of low-frequency rTMSon motor signs in Parkinson’s disease (PD), under a doubleblindplacebo-controlled trial design. PD patients were randomlyassigned to received either real (n 5 9) or sham (n 59) rTMS for 10 days. Each session comprises two trains of50 stimuli each delivered at 1 Hz and at 90% of daily restmotor threshold using a large circular coil over the vertex.The effect of the stimulation, delivered during the ON-period,was evaluated during both ON and OFF periods. Tests werecarried out before and after the stimulation period, and again1 week after. The effect of the stimulation was evaluatedthrough several gait variables (cadence, step amplitude, velocity,the CVstride-time, and the turn time), hand dexterity,and also the total and motor sections of the UPDRS. Onlythe total and motor section of the UPDRS and the turn timeduring gait were affected by the stimulation, the effectappearing during either ON or OFF evaluation, and mostimportantly, equally displayed in both real and sham group.The rest of the variables were not influenced. We concludethe protocol of stimulation used, different from most protocolsthat apply larger amount of stimuli, but very similar tosome previously reported to have excellent results, has notherapeutic value and should be abandoned. This contrastswith the positive reported effects using higher frequency andfocal coils. Our work also reinforces the need for sham stimulationwhen evaluating the therapeutic effect ofrTMS.