Effect of cumulative repetitive transcranial magnetic stimulation on freezing of gait in patients with atypical Parkinsonism: A pilot study.
OBJECTIVE
To investigate the potential of cumulative high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on freezing of gait in atypical Parkinsonism.


METHODS
Randomized, single-blinded, crossover study with a blinded observer.


METHODS
Eight patients with atypical Parkinsonism.


METHODS
All participants received HF-rTMS over the lower leg primary motor cortex (M1-LL) for 5 consecutive days. Alternative sham stimulation was also administered with a 2-week wash-out period. Freezing of Gait Questionnaire (FOG-Q), turn steps in the modified Standing Start 180° Turn Test, the Timed Up and Go (TUG) task, and the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) were performed before, after, and one week after rTMS.


RESULTS
All participants completed this study without any significant adverse effects. FOG-Q and turn steps revealed significant improvements over time in the rTMS compared with the sham stimulation (χ2=6.067, p=0.048 and χ2=9.083, p=0.011). In addition, the TUG task and UPDRS-III showed significant improvements over time in the rTMS compared with the sham stimulation (χ2=7.200, p=0.02 and χ2=7.000, p=0.030).


CONCLUSIONS
Cumulative HF-rTMS over the M1-LL might be effective for improving freezing of gait in patients with atypical Parkinsonism. Further investigation with a large number of participants is needed to clarify the effects of HF- rTMS on freezing of gait in atypical Parkinsonism.
Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Won Hyuk
WH
Chang
Min Su
MS
Kim
Jin Whan
JW
Cho
Jinyoung
J
Youn
Yun Kwan
YK
Kim
Sun Woong
SW
Kim
Ahee
A
Lee
Yun-Hee
YH
Kim
D000368:Aged; D018592:Cross-Over Studies; D005260:Female; D005615:Freezing; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020734:Parkinsonian Disorders / Q000534:rehabilitation* / Q000628:therapy; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D050781:Transcranial Magnetic Stimulation / Q000379:methods*