Objective: To compare the efficacy of rTMS [when given at primary motor area (MA), pre-motor area (PMA), supplementary motor area (SMA)] in Patients with Parkinson’s disease (PWP).

Background: Repetitive transcranial magnetic stimulation (rTMS) is known to modulate cortical plasticity. We evaluated effects rTMS at three cortical-foci in alleviating the severity of motor symptoms of PWP.

Methods: This was a randomized, single blind, sham-controlled, prospective study. The patients were randomly assigned to one of three groups MA (n=13); PMA (n = 18); SMA (n =19). The PWP received 3000 stimulations (sham followed by real) at 1 Hz(at MA), 1 Hz(at PMA) and 5 Hz(at SMA). All PWP received 4 sessions of sham rTMS followed by 4 sessions of real rTMS. The primary outcome measures were change of scores [validated clinical scales: UPDRS, PDQ39, HAMA, HAMD, PurduePegBoard(PPB)] from baseline after sham and real rTMS. A BOLD fMRI visuospatial task (acquired on 3T Phillips Achieva) was used to assess functional cortical plasticity outcomes.

Results: We observed significant improvements after real TMS compared to sham as reflected by UPDRS II (p=0.002), UPDRS III (p=0.002) and PDQ39 [Mobility (p=0.006) ADL (p=0.012)], PPB Right (p=0.001), PPB Left (p=0.003), PPB Assembly (p<0.001). These improvements were notable in MA and SMA groups but not in PMA along with task dependant activations. Significant activations were observed in MA and parietal association areas.

Conclusions: Clinically rTMS over MA and SMA offered significant benefits. This was corroborated by post TMS inhibition in MA and PMA and stimulation in SMA as seen by BOLD activity. A further investigation into the effects of rTMS using fMRI would give better insight into disease mechanisms.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/neuromodulation-by-rtms-in-parkinsons-disease-a-fmri-study/