title: A prospective pilot study of repetitive transcranial magnetic stimulation for gait dysfunction in vascular parkinsonism.
abstract: OBJECTIVE
  Vascular Parkinsonism (VP) causes significant gait dysfunction in patients who otherwise have good lower limb strength. Its pathophysiology is not clearly understood, and current treatment with physical therapy remains unsatisfactory. The study explores repetitive transcranial magnetic stimulation (rTMS) as a potential new and safe therapy for VP.
  
  
  METHODS
  We prospectively applied 5 Hz rTMS treatment to 5 patients who satisfied all the criteria for VP. Repetitive TMS was performed on 5 consecutive days and patients were assessed on (1) timed 10 m walk (T10MW), (2) Unified Parkinson's Disease Rating Scale (UPDRS) motor subsection, (3) Clinician's Global Impression of Change (CGIC), and (4) Patient's Global Impression of Change (PGIC), for up to 6 weeks post-rTMS.
  
  
  RESULTS
  All the outcome measures were found to have improved ratings post-rTMS when compared with baseline, and were statistically significant. The T10MW showed significant improvement at 4 weeks post-rTMS with a trend towards improvement at 2 weeks post-rTMS. The UPDRS motor subscores was significantly reduced at 2 weeks, 4 weeks and 6 weeks post-rTMS. The PGIC and CGIC scores were significantly better post-rTMS. The treatment was well-tolerated and all patients completed the study.
  
  
  CONCLUSIONS
  This study demonstrated for the first time that 5 sessions of rTMS could improve gait in a measurable way for up to 6 weeks without any significant side-effects. Repetitive TMS could be a potentially useful adjunct in rehabilitation of VP patients and further research is warranted.
authors.affiliation: National Neuroscience Institute, Singapore General Hospital Campus, Singapore. yip.chun.wai@sgh.com.sg
authors.forename: C W
authors.initials: CW
authors.lastname: Yip
authors.forename: P W T
authors.initials: PW
authors.lastname: Cheong
authors.forename: A
authors.initials: A
authors.lastname: Green
authors.forename: P K
authors.initials: PK
authors.lastname: Prakash
authors.forename: S K
authors.initials: SK
authors.lastname: Fook-Cheong
authors.forename: E K
authors.initials: EK
authors.lastname: Tan
authors.forename: Y L
authors.initials: YL
authors.lastname: Lo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003627:Data Interpretation, Statistical; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome