title: Efficacy of cumulative high-frequency rTMS on freezing of gait in Parkinson's disease.
abstract: OBJECTIVE
  Freezing of gait (FOG) affects mobility and balance seriously. Few reports have investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on FOG in Parkinson's disease (PD). We investigated the efficacy of high-frequency rTMS for the treatment of FOG in PD.
  
  
  METHODS
  Seventeen patients diagnosed with PD were recruited in a randomized, double-blinded, cross-over study. We applied high frequency rTMS (90% of resting motor threshold, 10 Hz, 1,000 pulses) over the lower leg primary motor cortex of the dominant hemisphere (M1-LL) for five sessions in a week. We also administered alternative sham stimulation with a two-week wash out period. The primary outcomes were measured before, immediately after, and one week after the intervention using the Standing Start 180° Turn Test (SS-180) with video analysis and the Freezing of Gait Questionnaire (FOG-Q). The secondary outcome measurements consisted of Timed Up and Go (TUG) tasks and the Unified Parkinson's Disease Rating Scale part III (UPDRS-III). Motor cortical excitability was also evaluated.
  
  
  RESULTS
  There were significant improvements in the step required to complete the SS-180 and FOG-Q in the rTMS condition compared to the sham condition, and the effects continued for a week. The TUG and UPDRS-III also showed significant ameliorations over time in the rTMS condition. The MEP amplitude at 120% resting motor threshold and intracortical facilitation also increased after real rTMS condition.
  
  
  CONCLUSIONS
  High frequency rTMS over the M1-LL may serve as an add-on therapy for improving FOG in PD.
authors.affiliation: Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Min Su
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Won Hyuk
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jin Whan
authors.initials: JW
authors.lastname: Cho
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jinyoung
authors.initials: J
authors.lastname: Youn
authors.affiliation: Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Yun Kwan
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
authors.forename: Sun Woong
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.|Department of Health Science and Technology, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
authors.forename: Yun-Hee
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D018592:Cross-Over Studies; D004311:Double-Blind Method; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D010300:Parkinson Disease / Q000503:physiopathology* / Q000628:therapy*; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D014741:Video Recording
keywords: Freezing of gait; Parkinson’s disease; brain stimulation; gait; transcranial magnetic stimulation