title: Low-frequency repetitive TMS of premotor cortex can reduce painful axial spasms in generalized secondary dystonia: a pilot study of three patients.
abstract: Dystonia is associated with excessive corticospinal motor output. Motor cortex excitability may be reduced by low-frequency repetitive transcranial magnetic stimulation (rTMS) of premotor cortical areas. We report the effects of 1 Hz rTMS applied at 90% of resting motor threshold over the left premotor cortex in an open pilot study of three patients with severe, generalized, secondary dystonia including painful spasms in the proximal and axial musculature. A 20-min session of premotor rTMS was daily performed during 5 consecutive days. The series of rTMS sessions dramatically reduced the painful spasms, for 3-8 days after the last session, without any other significant beneficial effects. However, a slight reduction of the Movement score of the Burke, Fahn and Marsden rating scale was observed for two patients, and of the Disability score for the third one. Low-frequency rTMS of the premotor cortex may improve some specific motor symptoms in severe, generalized dystonia. These results should prompt confirmation in a larger placebo-controlled study.
authors.affiliation: Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, 51, avenue de Lattre de Tassigny, 94010 Créteil, France. jean-pascal.lefaucheur@hmn.ap-hop-paris.fr <jean-pascal.lefaucheur@hmn.ap-hop-paris.fr>
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Lefaucheur
authors.forename: G
authors.initials: G
authors.lastname: Fénelon
authors.forename: I
authors.initials: I
authors.lastname: Ménard-Lefaucheur
authors.forename: S
authors.initials: S
authors.lastname: Wendling
authors.forename: J-P
authors.initials: JP
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000502:physiology; D004185:Disability Evaluation; D004421:Dystonia / Q000150:complications / Q000628:therapy*; D004574:Electromagnetic Fields; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010865:Pilot Projects; D013035:Spasm / Q000209:etiology / Q000628:therapy*