title: Cerebellar Intermittent Theta-Burst Stimulation and Motor Control Training in Individuals with Cervical Dystonia.
abstract: BACKGROUND
  There is emerging evidence that cervical dystonia is a neural network disorder with the cerebellum as a key node. The cerebellum may provide a target for neuromodulation as a therapeutic intervention in cervical dystonia.
  
  
  OBJECTIVE
  This study aimed to assess effects of intermittent theta-burst stimulation of the cerebellum on dystonia symptoms, quality of life, hand motor dexterity and cortical neurophysiology using transcranial magnetic stimulation.
  
  
  METHODS
  Sixteen participants with cervical dystonia were randomised into real or sham stimulation groups. Cerebellar neuromodulation was combined with motor training for the neck and an implicit learning task. The intervention was delivered over 10 working days. Outcome measures included dystonia severity and pain, quality of life, hand dexterity, and motor-evoked potentials and cortical silent periods recorded from upper trapezius muscles. Assessments were taken at baseline and after 5 and 10 days, with quality of life also measured 4 and 12 weeks later.
  
  
  RESULTS
  Intermittent theta-burst stimulation improved dystonia severity (Day 5, -5.44 points;p= 0.012; Day 10, -4.6 points;p= 0.025), however, effect sizes were small. Quality of life also improved (Day 5, -10.6 points,p= 0.012; Day 10, -8.6 points,p= 0.036; Week 4, -12.5 points,p= 0.036; Week 12, -12.4 points,p= 0.025), with medium or large effect sizes. There was a reduction in time to complete the pegboard task pre to post intervention (bothp< 0.008). Cortical neurophysiology was unchanged by cerebellar neuromodulation.
  
  
  CONCLUSIONS
  Intermittent theta-burst stimulation of the cerebellum may improve cervical dystonia symptoms, upper limb motor control and quality of life. The mechanism likely involves promoting neuroplasticity in the cerebellum although the neurophysiology remains to be elucidated. Cerebellar neuromodulation may have potential as a novel treatment intervention for cervical dystonia, although larger confirmatory studies are required.
authors.affiliation: Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia. lynley.bradnam@uts.edu.au.|Discipline of Physiotherapy, School of Health Sciences, Flinders University, Adelaide, SA 5001, Australia. lynley.bradnam@uts.edu.au.
authors.forename: Lynley V
authors.initials: LV
authors.lastname: Bradnam
authors.affiliation: Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia. michelle.mcdonnell@unisa.edu.au.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: McDonnell
authors.affiliation: Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, SA 5005, Australia. michael.ridding@adelaide.edu.au.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ridding
keywords: CDQ-24; TWSTRS; cerebellum; cervical dystonia; neuromodulation