Objective: Corticobasal ganglionic degeneration (CBGD) is a progressive taupathy involving frontal and parietal cortices as well as basal ganglia. The disease is clinically characterized by asymmetric parkinsonism affecting one limb, apraxia, dystonia, myoclonus, cortical sensory loss and cognitive impairment. Response to L-Dopa is frequently poor or transient, and treatment options are currently limited.

Background: A 58-year-old right-handed female, with 11 years of formal education, presented with decreased ability to perform purposeful movements, slowing of movements in the right hand and changes in speech. Her neurological examination revealed bradymimia, positive Myerson sign, right upper-extremity parkinsonism, ideomotor apraxia and brisk reflexes as well as cortical sensory loss and effortful, distorted speech production. Cranial MR imaging showed left frontoparietal atrophy and enlargement in the left ventricle while PET imaging clearly demonstrated the hypometabolism in the left frontal and parietal regions and left basal ganglia.

Methods: 10 sessions of real and sham repetitive transcranial magnetic stimulation (rTMS) were applied over the affected hemisphere motor cortex in intermittent theta burst stimulation (TBS) form with a gap of 3-months between the two interventions. The possible changes were investigated using Purdue Pegboard test, 9-hole peg test, and Boston Diagnostic Aphasia Examination (BDAE), Western Aphasia Battery (WAB) and Tulia apraxia subscales. Video recordings were simultaneously performed during certain tasks.

Results: The patient showed mild improvements in Purdue Pegboard test and 9-hole peg tests following real but not sham TBS. Video recordings showed mild but detectable improvements in several everyday tasks (e.g. drinking water from a cup, pouring water from a pitcher, etc.).

Conclusions: This case demonstrates mild improvements in a case with CBGD and encourages further randomized-controlled studies to investigate the possibility of induction of plasticity using TBS and whether this strategy could temporarily improve daily life activities and functionality of patients with CBGD during the course of the disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/theta-burst-repetitive-transcranial-magnetic-stimulation-in-a-case-with-cortical-basal-ganglionic-degeneration/