title: Intermittent theta-burst transcranial magnetic stimulation for treatment of Parkinson disease.
abstract: OBJECTIVE
  To investigate the safety and efficacy of intermittent theta-burst stimulation (iTBS) in the treatment of motor symptoms in Parkinson disease (PD).
  
  
  BACKGROUND
  Progression of PD is characterized by the emergence of motor deficits, which eventually respond less to dopaminergic therapy and pose a therapeutic challenge. Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in improving gait, a major cause of disability, and may provide a therapeutic alternative. iTBS is a novel type of rTMS that may be more efficacious than conventional rTMS.
  
  
  METHODS
  In this randomized, double-blind, sham-controlled study, we investigated safety and efficacy of iTBS of the motor and dorsolateral prefrontal cortices in 8 sessions over 2 weeks (evidence Class I). Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia, Unified Parkinson's Disease Rating Scale (UPDRS), and additional clinical, neuropsychological, and neurophysiologic measures.
  
  
  RESULTS
  We investigated 26 patients with mild to moderate PD: 13 received iTBS and 13 sham stimulation. We found beneficial effects of iTBS on mood, but no improvement of gait, bradykinesia, UPDRS, and other measures. EEG/EMG monitoring recorded no pathologic increase of cortical excitability or epileptic activity. Few reported discomfort or pain and one experienced tinnitus during real stimulation.
  
  
  CONCLUSIONS
  iTBS of the motor and prefrontal cortices appears safe and improves mood, but failed to improve motor performance and functional status in PD.
  
  
  METHODS
  This study provides Class I evidence that iTBS was not effective for gait, upper extremity bradykinesia, or other motor symptoms in PD.
authors.affiliation: Department of Neurology, University Hospital of Basel, Petersgraben 4, 4051 Basel, Switzerland. benningerd@uhbs.ch
authors.forename: D H
authors.initials: DH
authors.lastname: Benninger
authors.forename: B D
authors.initials: BD
authors.lastname: Berman
authors.forename: E
authors.initials: E
authors.lastname: Houdayer
authors.forename: N
authors.initials: N
authors.lastname: Pal
authors.forename: D A
authors.initials: DA
authors.lastname: Luckenbaugh
authors.forename: L
authors.initials: L
authors.lastname: Schneider
authors.forename: S
authors.initials: S
authors.lastname: Miranda
authors.forename: M
authors.initials: M
authors.lastname: Hallett
mesh_terms: D000368:Aged; D004311:Double-Blind Method; D004569:Electroencephalography; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000503:physiopathology* / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D013826:Theta Rhythm / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*