Objective: To evaluate transcranial magnetic stimulation (TMS) as a potential therapeutic tool for treatment of orthostatic hypotension (OH) in Parkinson’s disease (PD).

Background: Autonomic dysfunction, particularly OH, is a common non-motor symptom of PD that predicts poor outcomes when symptomatic or asymptomatic. Currently there are few effective treatments for OH in PD, and the underlying pathophysiologic mechanism remains incompletely understood. The central autonomic network (CAN), which regulates autonomic function, includes the medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC). Both of these structures are involved in PD pathology, and receive input from the hypothalamus which is implicated in PD autonomic failure. TMS is a noninvasive form of brain stimulation that is FDA approved to treat depression, and is instrumental in research investigating functional brain networks. The objective of this pilot study is to investigate the use of TMS of the mPFC as a targeted treatment of the central causes of OH in PD.

Method: Patients with clinically confirmed PD received stimulation of the dorsolateral prefrontal cortex (DLPFC), medial prefrontal cortex (MPFC), or primary somatosensory cortex (S1) in a triple crossover study design. Orthostatic vitals (lying and standing) were assessed before and after stimulation.

Results: A total of 28 PD patients with an age range of 55-82 were stimulated. 13 patients had clinical defined OH based on SBP drop > 20 mmHg and/or DBP drop > 10 mmHg. Stimulation at the MPFC, but not the DLPFC or S1, resulted in a significantly decreased orthostatic blood pressure reduction. One way ANOVA, however, did not show significant difference between stimulation locations.

Conclusion: The CAN is implicated in autonomic dysfunction in PD. Stimulation of the MPFC results in improvement in orthostatic blood pressure reduction, though it is not clear whether this finding is specific to this location. TMS could be a promising therapeutic tool in the treatment of OH in PD, which can cause significant impairment of quality of life.

« Back to 2024 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/transcranial-magnetic-stimulation-of-median-prefrontal-cortex-improves-orthostatic-hypotension-in-parkinsons-disease/