Effect of intermittent theta-burst stimulation on akinesia and sensorimotor integration in patients with Parkinson's disease.
High-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) has been shown to reduce akinesia in Parkinson's disease (PD). Given that the processing of sensory afferents is deficient in PD and might be involved in akinesia, we sought to determine whether or not the application of very HF rTMS [intermittent theta-burst stimulation (iTBS) protocol] over the M1 affected sensorimotor integration (SMI) and akinesia. The experiments were carried out in: (i) 11 patients taking their usual dopaminergic treatment ('on-drug'); (ii) eight of the latter patients after withdrawal of dopaminergic treatment ('off-drug'); and (iii) 10 de novo (drug-naive) patients. Sham stimulation was applied in 11 other patients in the 'on-drug' condition. SMI was investigated by conditioning a supra-threshold transcranial magnetic stimulation pulse in the motor region controlling the abductor pollicis brevis with a nerve shock over the median nerve at time intervals corresponding to short- and long-latency afferent inhibition (SAI and LAI) and afferent-induced facilitation (AIF). Akinesia was assessed with a pointing test. In on-drug, off-drug and de novo patients, akinesia in the contralateral arm was lower after iTBS. Sham stimulation had no effect. In on-drug patients (but not other groups), SMI was also influenced by iTBS, with an increase in AIF. No changes in SAI and LAI were observed. Our data suggest that iTBS might improve both akinesia and sensory processing in patients with PD taking levodopa.
Université Lille-Nord de France, EA 4559, CHRU de Lille, Hôpital Roger Salengro, F-59037 Lille Cedex, France. adrian.degardin@chru-lille.fr
Adrian
A
Degardin
David
D
Devos
Luc
L
Defebvre
Alain
A
Destée
Lucie
L
Plomhause
Philippe
P
Derambure
Hervé
H
Devanne
D000368:Aged; D000978:Antiparkinson Agents / Q000494:pharmacology; D019054:Evoked Potentials, Motor / Q000187:drug effects; D005260:Female; D006801:Humans; D007980:Levodopa / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex; D009048:Motor Skills / Q000187:drug effects; D010300:Parkinson Disease / Q000503:physiopathology*; D013826:Theta Rhythm; D050781:Transcranial Magnetic Stimulation
D000978:Antiparkinson Agents; D007980:Levodopa