High-frequency rTMS over the supplementary motor area for treatment of Parkinson's disease

Authors

  • Masashi Hamada MD,

    Corresponding author
    1. Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
    • Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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  • Yoshikazu Ugawa MD, PhD,

    1. Department of Neurology, School of Medicine, Fukushima Medical University, Fukushima, Japan
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  • Sadatoshi Tsuji MD, PhD

    1. Department of Neurology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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  • Members of the “The Effectiveness of rTMS on Parkinson's Disease Study Group, Japan” are listed as an Appendix.

Abstract

Dysfunction of the basal ganglia-thalamocortical motor circuit is a fundamental model to account for motor symptoms in Parkinson's disease (PD). Using high-frequency repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA), we investigated whether modulation of SMA excitability engenders therapeutic effects on motor symptoms in PD. In this double-blind placebo-controlled study, 99 patients were enrolled and assigned randomly to SMA-stimulation and sham-stimulation groups. For SMA stimulation, 20 trains of 50 transcranial magnetic stimuli at 5 Hz were delivered at an intensity of 110% active motor threshold for leg muscles in one session. The sham stimulation was 20 trains of electric stimuli given through electrodes fixed on the head to mimic the cutaneous sensation during rTMS. Each session of intervention was carried out once a week for the first 8 weeks. The SMA stimulation, in contrast to the sham stimulation, engendered significant improvements in total scores and motor scores of the Unified Parkinson's Disease Rating Scale. Mean improvements in motor scores were 4.5 points in the SMA-stimulation group and −0.1 points in the sham-stimulation group. Results indicate that 5 Hz rTMS over SMA modestly improves motor symptoms in PD patients; SMA is a potential stimulation site for PD treatment. © 2008 Movement Disorder Society

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