Objective: To investigate the safety and efficacy of rTMS in the treatment of Parkinson’s Disease associated pain.

Background: Pain is a prevalent symptom in patients with Parkinson’s disease (PD) and is a key unmet need in the management of non-motor symptoms of PD. Current evidence for treatment of this disabling symptom shows limited efficacy. Transcranial magnetic stimulation (TMS) is a non-invasive outpatient-based procedure that uses electromagnetically generated magnetic fields to induce electric currents in the cortex.  TMS is delivered as trains of pulses (rTMS) to prolong its effects.  Primary motor cortex (M1) is commonly targeted. While the exact mechanism of TMS-induced analgesia is unknown, it is thought to regulate the activity of the complex cortical and subcortical networks involved in the processing of painful signals and possibly strengthening the endogenous descending pain modulation system.

Method: Eleven patients suffering from refractory PD associated pain were recruited to the study.  Serial assessment of the patients included UPDRS(III), King’s PD Pain Scale, British Pain Society Rating Scale, Parkinson’s Disease Questionnaire-39, Non-motor symptoms scale, Hospital Anxiety and Depression Scale and Patient Global Impression of Change.  Each patient underwent a volumetric MRI scan. Nexstim© Navigated Brain Therapy (NBT®) System 2 was used to deliver ten sessions of rTMS stimulation of M1 at 90% of the Resting Motor Threshold at 2000 pulses/session. Daily pain scores and adverse events were recorded in pain diaries kept by patients.

Results: Ten patients completed the study.  One patient withdrew consent prior to the first stimulation session.  None of the patients reported a deterioration in their Parkinson’s disease control. There was significant improvement in the King’s PD Pain scale (P<0.05). Fluctuation-related pain in particular ‘off’ period pain showed a significant improvement with rTMS (P<0.05). Three patients who also suffered visceral pain confirmed improvement with rTMS of M1. Three patients suffering from radicular pain did not show any improvement in their pain.

Conclusion: rTMS is an effective treatment for Parkinson’s Disease associated pain. Patients who suffer from ‘off’ period pain show the best improvement with rTMS. rTMS had no effect on radicular pain in PD. A randomised control trial is advised to validate the findings in this open-label study.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/repetitive-transcranial-magnetic-stimulation-rtms-for-the-treatment-of-pain-in-parkinsons-disease-an-open-label-study/