title: Controlled study of 50-Hz repetitive transcranial magnetic stimulation for the treatment of Parkinson disease.
abstract: OBJECTIVE
  To investigate the safety and efficacy of 50-Hz repetitive transcranial magnetic stimulation (rTMS) in the treatment of motor symptoms in Parkinson disease (PD).
  
  
  BACKGROUND
  Progression of PD is characterized by the emergence of motor deficits that gradually respond less to dopaminergic therapy. rTMS has shown promising results in improving gait, a major cause of disability, and may provide a therapeutic alternative. Prior controlled studies suggest that an increase in stimulation frequency might enhance therapeutic efficacy.
  
  
  METHODS
  In this randomized, double blind, sham-controlled study, the authors investigated the safety and efficacy of 50-Hz rTMS of the motor cortices in 8 sessions over 2 weeks. 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, neurophysiological, and neuropsychological parameters. In addition, the safety of 50-Hz rTMS was tested with electromyography-electroencephalogram (EMG-EEG) monitoring during and after stimulation.
  
  
  RESULTS
  The authors investigated 26 patients with mild to moderate PD: 13 received 50-Hz rTMS and 13 sham stimulation. The 50-Hz rTMS did not improve gait, bradykinesia, and global and motor UPDRS, but there appeared a short-lived "on"-state improvement in activities of daily living (UPDRS II). The 50-Hz rTMS lengthened the cortical silent period, but other neurophysiological and neuropsychological measures remained unchanged. EMG/EEG recorded no pathological increase of cortical excitability or epileptic activity. There were no adverse effects.
  
  
  CONCLUSIONS
  It appears that 50-Hz rTMS of the motor cortices is safe, but it fails to improve motor performance and functional status in PD. Prolonged stimulation or other techniques with rTMS might be more efficacious but need to be established in future research.
authors.affiliation: Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. David.Benninger@chuv.ch
authors.forename: David H
authors.initials: DH
authors.lastname: Benninger
authors.forename: Kazumi
authors.initials: K
authors.lastname: Iseki
authors.forename: Sarah
authors.initials: S
authors.lastname: Kranick
authors.forename: David A
authors.initials: DA
authors.lastname: Luckenbaugh
authors.forename: Elise
authors.initials: E
authors.lastname: Houdayer
authors.forename: Mark
authors.initials: M
authors.lastname: Hallett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D004569:Electroencephalography; D004576:Electromyography; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation; D006801:Humans; D018476:Hypokinesia / Q000209:etiology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology; D009068:Movement / Q000502:physiology; D010300:Parkinson Disease / Q000534:rehabilitation*; D012146:Rest / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome