title: Effect of Dual-Mode and Dual-Site Noninvasive Brain Stimulation on Freezing of Gait in Patients With Parkinson Disease.
abstract: To investigate the effect of dual-mode noninvasive brain stimulation (NIBS) with high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex of the lower leg and anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex compared with rTMS alone in patients with Parkinson disease (PD) with freezing of gait (FOG).
  
  
  
  Randomized, double-blind, controlled study.
  
  
  
  Outpatient rehabilitation clinics.
  
  
  
  Patients diagnosed as having PD with FOG (N=32).
  
  
  
  Patients in the dual-mode group underwent 5 consecutive daily sessions of dual-mode NIBS with high-frequency rTMS and tDCS simultaneously, whereas patients in the rTMS group underwent high-frequency rTMS and sham tDCS.
  
  
  
  Assessments of FOG and motor, ambulatory, and cognitive function were performed 3 times: at baseline before NIBS, immediately after NIBS, and 1 week after cessation of NIBS.
  
  
  
  Serious adverse effects were not observed in either group. Significant changes over time were observed in FOG, motor function, and ambulatory function in each group; however, there was no significant difference between the 2 groups. Executive function showed significant improvement after NIBS only in the dual-mode group.
  
  
  
  These results suggest the potential for dual-mode NIBS to modulate 2 different cortices simultaneously. Dual-mode NIBS might be considered a novel therapeutic approach for patients with PD.
authors.affiliation: Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Won Hyuk
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Department of Physical and Rehabilitation Medicine, Wonkwang University School of Medicine, Ikan, Chonbuk, Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Eunhee
authors.initials: E
authors.lastname: Park
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 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, 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 Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 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 Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Science and Technology, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea. Electronic address: yunkim@skku.edu.
authors.forename: Yun-Hee
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D003071:Cognition; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D020233:Gait Disorders, Neurologic / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D010300:Parkinson Disease / Q000628:therapy*; D017397:Prefrontal Cortex / Q000503:physiopathology; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016138:Walking
keywords: Gait disorders, neurologic; Parkinson disease; Rehabilitation; Transcranial direct current stimulation; Transcranial magnetic stimulation