title: High-frequency repetitive transcranial magnetic stimulation over the primary foot motor area in Parkinson's disease.
abstract: BACKGROUND
  Repetitive transcranial magnetic stimulation (rTMS) has been reported to be clinically effective for treating motor symptoms in Parkinson's disease (PD). Few studies have been performed reporting the effects of rTMS on non-motor symptoms such as depression and apathy in PD.
  
  
  OBJECTIVE
  We assessed the effects of high-frequency (HF) rTMS over the primary motor (M1) foot area on motor symptoms, depression and apathy scales, and sensory symptoms in PD.
  
  
  METHODS
  We investigated the efficacy of 3 consecutive days of HF-rTMS over the M1 foot area in 21 patients with PD using a randomized, double-blind cross-over trial compared with sham stimulation. Motor effects were evaluated using the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the self-assessment motor score, the visual analog scale (VAS), the 10-m walking test, and finger tapping. Non-motor effects were analyzed using the Montgomery Asberg Depression Rating Scale, the Apathy Scale, and quantitative sensory testing.
  
  
  RESULTS
  HF-rTMS significantly improved UPDRS-III (P < 0.001), VAS (P < 0.001), the walking test (P = 0.014), self-assessment motor score (P = 0.010), and finger tapping measurement (P < 0.05) compared to sham stimulation. In contrast, no significant improvement was observed in depression and apathy scales. Consecutive days of rTMS did not significantly increase the improvement in motor symptoms. There were no adverse effects following rTMS on patients with PD.
  
  
  CONCLUSIONS
  We confirmed that HF-rTMS over the M1 foot area significantly improved motor symptoms in patients with PD. In addition, daily repeated stimulation was not significantly more effective than a single session of stimulation, but may be effective for maintaining the improvement in motor symptoms in patients with PD.
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neuromodulation and Neurosurgery, Office for University-Industry Collaboration, Osaka University, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Maruo
authors.forename: Koichi
authors.initials: K
authors.lastname: Hosomi
authors.forename: Toshio
authors.initials: T
authors.lastname: Shimokawa
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kishima
authors.forename: Satoru
authors.initials: S
authors.lastname: Oshino
authors.forename: Shayne
authors.initials: S
authors.lastname: Morris
authors.forename: Yu
authors.initials: Y
authors.lastname: Kageyama
authors.forename: Masaru
authors.initials: M
authors.lastname: Yokoe
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
authors.forename: Youichi
authors.initials: Y
authors.lastname: Saitoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy; D018592:Cross-Over Studies; D003863:Depression / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005528:Foot / Q000294:innervation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009044:Motor Cortex / Q000502:physiology*; D010300:Parkinson Disease / Q000150:complications / Q000523:psychology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation
keywords: Parkinson's disease; Primary foot motor area; Repetitive transcranial magnetic stimulation