Objective: To determine the effects of 1Hz supplementary motor area (SMA) repetitive transcranial magnetic stimulation (rTMS) and gait training on freezing of gait (FOG).

Background: There is growing evidence of increased functional connectivity between mesencephalic locomotor region (MLR) and the SMA in FOG.  Reduction of top-down control of locomotion may be an effective treatment strategy for FOG.

Method: 15 patients with Parkinson’s Disease (PD) and FOG were randomized (2:1) to receive 10 daily sessions of real (1 Hz, 110% RMT, 3000 pulses; n=10) or sham rTMS delivered to the SMA.  Both groups received gait training aiming to increase gait automaticity.  Objective spatiotemporal parameters, UPDRS, nFOGQ were obtained in the OFF and ON state, with and without a dual task, before and after intervention.  nFOGQ was obtained at 1, 2 and 3 months post intervention.

Results: Active group was aged 66.5 (8.3), 6 males, disease duration 10 (9.7).  Sham group was aged 69.8 (8.2), 4 male, disease duration 5 (8.2).  There was a significant interaction by treatment group and time, demonstrating a decrease in nFOGQ score pre and post intervention in the active (nFOGQ score 21 to 7 p=0.0058) not in the sham (19 to 18).  There were non-significant reductions in all spatiotemporal parameters, in both groups, although greater in the active group for each parameter.

Conclusion: Inhibition of SMA via 1Hz rTMS appears to improve FOG as quantified by the nFOGQ. Larger studies of this intervention are necessary to determine efficacy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/randomized-controlled-trial-of-1hz-sma-rtms-gait-training-for-freezing-of-gait/