Objective: To evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in the treatment of pain and fatigue in Parkinson’s disease (PD).

Background: A broad range of non-motor symptoms (NMS) occurs in PD; amongst these pain and fatigue can be severe and debilitating problems¹. The pathophysiology of pain and fatigue in PD is still not clear and there is limited evidence of successful drugs for their treatment². RTMS is a promising tool for the treatment for chronic neuropathic and non-neuropathic pain of different etiologies, as well as fatigue³.

Method: PD patients attending our clinic from 2016 to 2018 were screened for pain and fatigue. Patients who met inclusion criteria were included in the study and randomly assigned into two groups, one receiving active and one sham rTMS. The treatment protocol consisted of one rTMS session per day, for five consecutive days. Each treatment session consisted of 25 series of 8s pulses, with 52s interval between series, at a stimulation frequency of 10Hz and 80% resting motor threshold intensity, over M1 contralateral to the most affected side. Before and after the treatment (day 5, 8, 15, 30), patients were assessed with the following clinical scales: visual analogue scale for pain (VAS) and fatigue (VAFS), King’s Parkinson’s Disease Pain Scale (KPDPS), Fatigue Severity Scale (FSS), PD quality of life questionnaire-8 (PDQ-8), Beck Depression Inventor (BDI), MDS-UPDRS part III.

Results: Thirty (16.7%) PD patients affected by pain and fatigue were found, 21 of which met the inclusion criteria. Six of them were included into the study, 3 of which underwent the active and 3 the sham stimulation. The two groups did not differ at the baseline assessment, while in the active group there was an improvement (from 30-50%) of the VAS, VAFS, KPDPS, and FSS scale scores. This improvement was not observed in the sham group. There was not a clear difference before and after treatment in the BDI, PDQ-8, and MDS-UPDRS III scales in both groups.

Conclusion: Our results show an improvement of pain and fatigue in the group receiving active rTMS, compared to the control group receiving sham stimulation.  The improvement of pain and fatigue in the active group lasted for the duration of the study (i.e. 30 days). Despite the small number, the results are very encouraging, but need a larger number of patients to be confirmed.

References: 1)Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson’s disease: dopaminergic pathophysiology and treatment. Lancet Neurol. 2009 May;8(5):464-74. doi: 10.1016/S1474-4422(09)70068-7. PMID: 19375664. 2)Seppi K, Weintraub D, Coelho M, Perez-Lloret S, Fox SH, Katzenschlager R, Hametner EM, Poewe W, Rascol O, Goetz CG, Sampaio C. The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26 Suppl3:S42-80 3)Jean-Pascal Lefaucheur, André Aleman, Chris Baeken, David H. Benninger, Jérôme Brunelin, Vincenzo Di Lazzaro, Saša R. Filipović, Christian Grefkes, Alkomiet Hasan, Friedhelm C. Hummel, Satu K. Jääskeläinen, Berthold Langguth, Letizia Leocani, Alain Londero, Raffaele Nardone, Jean-Paul Nguyen, Thomas Nyffeler, Albino J. Oliveira-Maia, Antonio Oliviero, Frank Padberg, Ulrich Palm, Walter Paulus, Emmanuel Poulet, Angelo Quartarone, Fady Rachid, Irena Rektorová, Simone Rossi, Hanna Sahlsten, Martin Schecklmann, David Szekely, Ulf Ziemann, Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018), Clinical Neurophysiology, Volume 131, Issue 2, 2020

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