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High-frequency rTMS over the supplementary motor area improves freezing of gait in Parkinson's disease: a randomized controlled trial

  • Tao-Mian Mi
    Affiliations
    National Clinical Research Center for Geriatric Disorders, Beijing, China

    Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China

    Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada
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  • Saurabh Garg
    Affiliations
    Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada
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  • Fang Ba
    Affiliations
    Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
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  • Ai-Ping Liu
    Correspondence
    Corresponding author. 443 Huangshan Road, Hefei, Anhui, 230027, China.
    Affiliations
    University of Science and Technology of China, Hefei, Anhui, China
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  • Tao Wu
    Affiliations
    Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
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  • Lin-Lin Gao
    Affiliations
    Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
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  • Xiao-Juan Dan
    Affiliations
    Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China
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  • Piu Chan
    Correspondence
    Corresponding author. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
    Affiliations
    National Clinical Research Center for Geriatric Disorders, Beijing, China

    Department of Neurology, Neurobiology and Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing Institute for Brain Disorders, Beijing, China

    Clinical Center for Parkinson's Disease, Capital Medical University, Beijing, China

    Key Laboratory for Neurodegenerative Disease of the Ministry of Education, Beijing Key Laboratory for Parkinson's Disease, Beijing, China
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  • Martin J. McKeown
    Affiliations
    Pacific Parkinson's Research Centre, University of British Columbia, Vancouver, Canada

    Department of Medicine (Neurology), University of British Columbia, Vancouver, Canada
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      Highlights

      • Significant clinical improvements were only found after real rTMS stimulation.
      • The beneficial effects of rTMS could last at least 4 weeks after stimulation.
      • High-frequency rTMS over SMA may ultimately serve as an add-on therapy for FOG in PD.

      Abstract

      Introduction

      Freezing of gait (FOG) contributes to falls in Parkinson's disease (PD), but robust, effective treatments remain elusive. There is evidence indicating that the supplementary motor area (SMA) plays an important role in the pathogenesis of FOG and may therefore be a potential neuromodulation target. The present study explored the clinical efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the SMA on FOG in PD patients.

      Methods

      A group of 30 PD patients with FOG were enrolled in a randomized, double-blind, sham-controlled trial. Patients were randomly allocated 2:1 to receive ten sessions of either real (N = 20) or sham (N = 10) 10 Hz rTMS over SMA. The patients were assessed at baseline (T0), after the 5th (T1) and 10th (T2) sessions, and then 2 weeks (T3) and 4 weeks (T4) after the last session. The primary clinical outcome was the Freezing of Gait Questionnaire score (FOGQ), with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor scores (MDS-UPDRS III) and Timed Up and Go test as secondary clinical outcomes. All the assessments were carried out at the “ON” state.

      Results

      With a four week's follow-up, there were significant interaction effects in the FOGQ (effect of group*time, p = 0.04), MDS-UPDRS III (p = 0.02) and several gait variables (total duration, p < 0.01; cadence, p = 0.04; turn duration, p = 0.01; and turn to sit duration, p = 0.02). Post-hoc analyses revealed a significantly decreased FOGQ score at T2 and T4, and significant improvements of MDS-UPDRS III and gait variables at T1, T2, T3 and T4 in the rTMS group. No significant improvements were found in the sham group.

      Conclusion

      High-frequency rTMS over SMA may ultimately serve as an add-on therapy for alleviating FOG in PD patients.

      Keywords

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