title: Bilateral low frequency rTMS of the primary motor cortex may not be a suitable treatment for levodopa-induced dyskinesias in late stage Parkinson's disease.
abstract: BACKGROUND
  In late stage Parkinson patients there is an unmet need for new treatments to adequately control motor complications, especially dyskinesias. In several preliminary studies, it has been suggested that applying unilateral low-frequency repetitive transcranial magnetic stimulation (LF rTMS), delivered at the primary motor cortex (MC) or the supplementary motor area (SMA), may reduce levodopa-induced dyskinesias (LID), either in a single or a multiple session stimulation protocol. In our current clinical research, we examined whether single or multiple (accelerated) sham-controlled bilateral LF rTMS session(s) applied to the primary motor cortices are able to reduce levodopa-induced dyskinesias in patients with advanced Parkinson's disease.
  
  
  METHODS
  During a levodopa challenge test, we first investigated the effect of a single sham-controlled session of LF rTMS (1 Hz) to both left and right primary motor cortical areas on dyskinesias and motor function in nine late-stage Parkinson patients. In a second study, patients were assigned to a five day sham-controlled bilateral motor cortex cross-over accelerated LF rTMS protocol and effects on dyskinesias, motor and executive function and emotional status were assessed.
  
  
  RESULTS
  We found no significant clinical change in levodopa-induced dyskinesias and motor function with either stimulation protocol.
  
  
  CONCLUSIONS
  One or multiple bilateral LF rTMS session(s) applied to the primary motor cortex were unable to reduce levodopa-induced dyskinesias in late-stage Parkinson patients.
authors.forename: Anja
authors.initials: A
authors.lastname: Flamez
authors.forename: Ann
authors.initials: A
authors.lastname: Cordenier
authors.forename: Sylvie
authors.initials: S
authors.lastname: De Raedt
authors.forename: Véronique
authors.initials: V
authors.lastname: Michiels
authors.forename: Sara
authors.initials: S
authors.lastname: Smetcoren
authors.forename: Annick
authors.initials: A
authors.lastname: Van Merhaegen-Wieleman
authors.forename: Eva
authors.initials: E
authors.lastname: Parys
authors.forename: Jacques
authors.initials: J
authors.lastname: De Keyser
authors.forename: Chris
authors.initials: C
authors.lastname: Baeken
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000009:adverse effects*; D004409:Dyskinesia, Drug-Induced / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007980:Levodopa / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex; D010300:Parkinson Disease / Q000188:drug therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa