title: Increased cerebellar activation after repetitive transcranial magnetic stimulation over the primary motor cortex in patients with multiple system atrophy.
abstract: BACKGROUND
  Previous review reported that the high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor area (M1) of Parkinson's disease (PD) patients could alleviate their symptoms. This study aimed to investigate the effect of rTMS over the left M1 of patients with multiple system atrophy (MSA).
  
  
  METHODS
  Fifteen MSA patients were randomly assigned to receive a 10-session real (EP: group of experimental patients; n=7) or sham (CP: group of control patients; n=8) rTMS stimulation over two weeks. The overall experimental procedure consisted of two functional magnetic resonance imaging (fMRI) sessions, before and after a 10-session rTMS treatment. A complex self-paced sequential tapping task was performed during fMRI scanning. In addition, 18 age and gender matched healthy controls (HC) were enrolled. Subjects from the HC group did not receive any rTMS treatment and they underwent fMRI examination only once. The primary end point was the motor score change of the Unified Multiple System Atrophy Rating Scale (UMSARS-II) measured before and after the 5th and 10th session. Task-related activation was also compared among groups.
  
  
  RESULTS
  After active rTMS treatment, only patients of EP group significant improvement in UMSARS-II score. Compared to HC, MSA patients showed significant activation over similar brain areas except for the cerebellum. Increased activation was obtained in the bilateral cerebellum after rTMS treatment in the EP group. On the contrary, no increased activation was identified in the CP group.
  
  
  CONCLUSIONS
  Our results highlight rTMS over M1 induced motor improvement in MSA patients that may be associated with increased activation in the cerebellum.
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Han
authors.initials: H
authors.lastname: Wang
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Linling
authors.initials: L
authors.lastname: Li
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Tianxia
authors.initials: T
authors.lastname: Wu
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Hou
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Wu
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Yunhai
authors.initials: Y
authors.lastname: Qiu
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Feng
authors.affiliation: 1 Department of Neurology, Peking Union Medical College Hospital, Beijing 100730, China ; 2 Research Center for Neural Engineering, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China ; 3 National Institute of Neurologic Disorder and Stroke, National Institutes of Health, Bethesda, Maryland, USA ; 4 Department of Radiology, Peking Union Medical College Hospital, Beijing 100730, China ; 5 Neuroscience Center, Chinese Academy of Medical Sciences Neuroscience, Beijing 100730, China.
authors.forename: Liying
authors.initials: L
authors.lastname: Cui
keywords: Multiple system atrophy (MSA); cerebellum; functional magnetic resonance imaging (fMRI); repetitive transcranial magnetic stimulation (rTMS); unified multiple system atrophy rating scale (UMSARS)