title: Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy in Parkinson Disease: A Meta-Analysis.
abstract: OBJECTIVE
  Several studies have reported repetitive transcranial magnetic stimulation (rTMS) therapy as an effective treatment for the control of motor symptoms in Parkinson disease. The objective of the study is to quantify the overall efficacy of this treatment.
  Systematic review and meta-analysis.
  
  
  METHODS
  We reviewed the literature on clinical rTMS trials in Parkinson disease since the technique was introduced in 1980. We used the following databases: MEDLINE, Web of Science, Cochrane, and CINAHL.
  
  
  METHODS
  
  
  
  METHODS
  Patients with Parkinson disease who were participating in prospective clinical trials that included an active arm and a control arm and change in motor scores on Unified Parkinson's Disease Rating Scale as the primary outcome. We pooled data from 21 studies that met these criteria. We then analyzed separately the effects of low- and high-frequency rTMS on clinical motor improvements.
  
  
  RESULTS
  The overall pooled mean difference between treatment and control groups in the Unified Parkinson's Disease Rating Scale motor score was significant (4.0 points, 95% confidence interval, 1.5, 6.7; P = .005). rTMS therapy was effective when low-frequency stimulation (≤ 1 Hz) was used with a pooled mean difference of 3.3 points (95% confidence interval 1.6, 5.0; P = .005). There was a trend for significance when high-frequency stimulation (≥ 5 Hz) studies were evaluated with a pooled mean difference of 3.9 points (95% confidence interval, -0.7, 8.5; P = .08). rTMS therapy demonstrated benefits at short-term follow-up (immediately after a treatment protocol) with a pooled mean difference of 3.4 points (95% confidence interval, 0.3, 6.6; P = .03) as well as at long-term follow-up (average follow-up 6 weeks) with mean difference of 4.1 points (95% confidence interval, -0.15, 8.4; P = .05). There were insufficient data to statistically analyze the effects of rTMS when we specifically examined bradykinesia, gait, and levodopa-induced dyskinesia using quantitative methods.
  
  
  CONCLUSIONS
  rTMS therapy in patients with Parkinson disease results in mild-to-moderate motor improvements and has the potential to be used as an adjunct therapy for the treatment of Parkinson disease. Future large, sample studies should be designed to isolate the specific clinical features of Parkinson disease that respond well to rTMS therapy.
authors: Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, 3450 Hull Road, Gainesville, FL 32607(∗). Electronic address: aparna.shukla@neurology.ufl.edu.
authors: Aparna
authors: A
authors: Wagle Shukla
authors: Department of Health Outcomes and Policy, Clinical and Translational Science Institute, University of Florida, Gainesville, FL(†).
authors: Jonathan J
authors: JJ
authors: Shuster
authors: Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(‡).
authors: Jae Woo
authors: JW
authors: Chung
authors: Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL; Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL(§).
authors: David E
authors: DE
authors: Vaillancourt
authors: Brain Rehabilitation Research Center of Excellence and Department of Physical Therapy, University of Florida, Gainesville, FL(‖).
authors: Carolynn
authors: C
authors: Patten
authors: Department of Neurology and Surgical Movement Disorders, University of California, San Francisco, CA(¶).
authors: Jill
authors: J
authors: Ostrem
authors: Department of Neurology and Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, FL(#).
authors: Michael S
authors: MS
authors: Okun
mesh_terms: D006801:Humans; D009043:Motor Activity / Q000502:physiology*; D010300:Parkinson Disease / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*