title: Excitatory deep repetitive transcranial magnetic stimulation with H-coil as add-on treatment of motor symptoms in Parkinson's disease: an open label, pilot study.
abstract: BACKGROUND
  Repetitive transcranial magnetic stimulation (rTMS) has been proposed as a potential treatment for Parkinson's disease (PD). H-coils, inducing deeper and wider magnetic fields compared to traditional coils, may be potentially useful in PD, characterized by widespread, bilateral involvement of cortico-subcortical circuits.
  
  
  OBJECTIVE
  To evaluate the safety of repetitive deep TMS (rDTMS) with H-coil as add-on treatment of motor symptoms in PD.
  
  
  METHODS
  Twenty-seven PD patients (aged 60.1 ± 6.8 y; PD-duration: 6.3 ± 2.8 y; motor-UPDRS: 39.6 ± 10.1) underwent 12 rDTMS sessions over 4 weeks at excitatory (10 Hz) frequency over primary motor (M1) and bilateral prefrontal (PF) regions. Motor UPDRS off therapy was assessed before and after the last rDTMS session, together with safety records at each treatment session.
  
  
  RESULTS
  No drop-outs or adverse events were recorded. Motor UPDRS significantly improved after rDTMS (10.8 points average reduction; P < 0.0001).
  
  
  CONCLUSIONS
  High-frequency rDTMS might be a safe treatment for PD motor symptoms. Further placebo-controlled, randomized studies are warranted.
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Spagnolo
authors.affiliation: Neurological Department, San Raffaele Hospital, Milan, Italy.
authors.forename: M A
authors.initials: MA
authors.lastname: Volonté
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fichera
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Chieffo
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Houdayer
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bianco
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Coppi
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nuara
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Straffi
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Maggio
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Ferrari
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Dalla Libera
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Velikova
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy; San Raffaele Vita-Salute University, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Comi
authors.affiliation: Neuroscience Laboratory, Ben-Gurion University of the Negev, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Zangen
authors.affiliation: Experimental Neurophysiology Unit, Institute of Experimental Neurology (INSPE), Scientific Institute Hospital San Raffaele, Via Olgettina 48, I-20132 Milan, Italy; Neurological Department, San Raffaele Hospital, Milan, Italy. Electronic address: letizia.leocani@hsr.it.
authors.forename: L
authors.initials: L
authors.lastname: Leocani
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D012107:Research Design; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: H-coil; Parkinson's disease; Repetitive transcranial magnetic stimulation