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Transcranial Magnetic Stimulation Promotes Gait Training in Parkinson Disease
Author(s) -
Chung Chloe LauHa,
Mak Margaret KitYi,
Hallett Mark
Publication year - 2020
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25881
Subject(s) - transcranial magnetic stimulation , physical medicine and rehabilitation , medicine , motor cortex , parkinson's disease , primary motor cortex , physical therapy , treadmill , randomized controlled trial , placebo , gait , psychology , stimulation , disease , alternative medicine , pathology
Objective To determine whether priming with 1 or 25Hz repetitive transcranial magnetic stimulation (rTMS) will enhance the benefits from treadmill training up to 3 months postintervention in people with Parkinson disease (PD), and to evaluate the underlying changes in cortical excitability. Methods This randomized double‐blind, placebo‐controlled trial was conducted between October 2016 and December 2018. Fifty‐one participants with PD were randomized to receive 12 sessions of rTMS (25Hz, 1Hz, or sham) followed by treadmill training. All participants were assessed at baseline and 1 day, 1 month, and 3 months postintervention. Primary outcome was fastest walking speed, and secondary outcomes were timed up‐and‐go test (TUG), dual‐task TUG (DT‐TUG), motor section of the Movement Disorder Society–Unified Parkinson's Disease Rating Scale (MDS‐UPDRS‐III), and electrophysiological evaluation of cortical excitability by TMS. Results The 1 and 25Hz rTMS groups produced a greater improvement in fastest walking speed at 1 day and 3 months postintervention than the sham group. Only the 1 and 25Hz rTMS groups sustained the improvements in TUG, and had a significant improvement in DT‐TUG and MDS‐UPDRS‐III for up to 3 months. Behavioral improvements correlated with increased cortical silent period and short‐interval intracortical inhibition in both groups receiving real rTMS. Interpretation Priming with 1 and 25Hz rTMS can augment the benefits of treadmill training and lead to long‐term motor improvement up to 3 months postintervention. The motor improvement at follow‐up was associated with a normalization of cortical excitability, which in turn suggests an alteration of the homeostatic plasticity range. Rebalancing cortical excitability by rTMS appears critical for plasticity induction. ANN NEUROL 2020;88:933–945