title: Metabolic changes induced by theta burst stimulation of the cerebellum in dyskinetic Parkinson's disease patients.
abstract: BACKGROUND
  Cerebellar repetitive transcranial magnetic stimulation may be effective in reducing peak-dose levodopa induced dyskinesia in Parkinson's disease patients. It was proposed that the antidyskinetic effect could be due to modulation of cerebello-thalamo-cortical pathways. However the neural basis for these clinical effects have not yet been demonstrated.
  
  
  METHODS
  We investigated the effects of repeated sessions of cerebellar continuous theta burst stimulation in Parkinson's disease patients with levodopa induced dyskinesia on brain metabolism by means of positron emission tomography scan with fluorodeoxyglucose ((18)F-FDG) to characterize the specific cerebral network activated by cerebellar stimulation in these patients.
  
  
  RESULTS
  We found that five days of bilateral cerebellar continuous theta burst stimulation (cTBS) were effective in reducing levodopa induced dyskinesia. Clinical changes were paralleled by a reduction of (18)F-FDG metabolism in the cerebellum as revealed by positron emission tomography imaging. We found a global decrease in the metabolism of the bilateral cerebellar hemispheres, and a significant decrease in (18)F-FDG uptake in correspondence of bilateral dentate nucleus.
  
  
  CONCLUSIONS
  Our study demonstrates the antidyskinetic effect of cerebellar cTBS in Parkinson's disease patients with levodopa induced dyskinesia, is paralleled by modulation of the activity of the pathways connecting the cerebellar cortex with the deep cerebellar nuclei, confirming the hypothesis that the motor cerebellar circuit is involved in the generations of levodopa induced dyskinesia.
authors.affiliation: UOC Neurologia, S. Eugenio Hospital, Rome, Italy.
authors.forename: Livia
authors.initials: L
authors.lastname: Brusa
authors.forename: Roberto
authors.initials: R
authors.lastname: Ceravolo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Kiferle
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Monteleone
authors.forename: Cesare
authors.initials: C
authors.lastname: Iani
authors.forename: Orazio
authors.initials: O
authors.lastname: Schillaci
authors.forename: Paolo
authors.initials: P
authors.lastname: Stanzione
authors.forename: Giacomo
authors.initials: G
authors.lastname: Koch
mesh_terms: D000368:Aged; D002531:Cerebellum / Q000000981:diagnostic imaging / Q000378:metabolism*; D004409:Dyskinesia, Drug-Induced / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000000981:diagnostic imaging / Q000378:metabolism; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000628:therapy; D049268:Positron-Emission Tomography / Q000379:methods; D013826:Theta Rhythm / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
chemical_list: D007980:Levodopa