title: Immediate placebo effect in Parkinson's disease--is the subjective relief accompanied by objective improvement?
abstract: BACKGROUND
  A recent well-conducted meta-analysis showed that placebo effect is associated with a possible small benefit for subjective outcomes, but has no significant effects on objective outcomes.
  
  
  OBJECTIVE
  Herein, we aimed to investigate the immediate effects of two different types of placebo [placebo pill and sham transcranial magnetic stimulation (TMS)] in Parkinson's disease (PD) patients and compared them to the standard treatment (levodopa) in a proper randomized, double-blind, crossover clinical trial.
  
  
  METHODS
  PD patients received three different interventions on different days: levodopa, placebo pill, and sham TMS. The motor function was assessed using simple and choice reaction time, Unified Parkinson's Disease Rating Scale (UPDRS), finger tapping, Purdue Pegboard test, time to button up, walking time and supination-pronation. The subjective motor function was measured by a visual analogue scale (VAS).
  
  
  RESULTS
  The results showed that there was a significant motor function in the motor function only after the treatment with levodopa, but not after treatment with placebo pills or sham TMS. However, patients reported a similar subjective improvement in motor function indexed by VAS following these three treatments.
  
  
  CONCLUSIONS
  These results suggest that placebo interventions in PD may have an immediate subjective sensation of improvement but result in no significant objective motor changes compared with levodopa treatment. Although physiological changes are possible after a placebo intervention, our findings suggest that the acute placebo effect in PD may be the result of the subjective change in the motor rating only.
authors.affiliation: Harvard Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass, USA. ffregni@bidmc.harvard.edu
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Paulo S
authors.initials: PS
authors.lastname: Boggio
authors.forename: Felix
authors.initials: F
authors.lastname: Bermpohl
authors.forename: Fernanda
authors.initials: F
authors.lastname: Maia
authors.forename: Sergio P
authors.initials: SP
authors.lastname: Rigonatti
authors.forename: Egberto R
authors.initials: ER
authors.lastname: Barbosa
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects*; D010300:Parkinson Disease / Q000523:psychology* / Q000628:therapy*; D015990:Placebo Effect; D010919:Placebos / Q000627:therapeutic use; D011930:Reaction Time / Q000187:drug effects; D050781:Transcranial Magnetic Stimulation
chemical_list: D000978:Antiparkinson Agents; D010919:Placebos; D007980:Levodopa