Objective: The aim of the RCT was to study the effectiveness of rTMS on the activities of daily living, behavioural and cognitive ability (A-B-C) of PD patients.

Background: PD is a progressive neurodegenerative disease which led to 3.2 million DALYs and 2,11,296 deaths globally in 2016 (1). From 1990 to 2019, India’s crude estimate prevalence of PD increased by 105.9% and the crude DALY estimate increased by 85.2% with around 45,300 deaths and 7,71,000 people suffering from the disease (2). Patients experience rigidity, tremors, motor disturbances, postural instability, imbalance and gait difficulties. Patients complain of memory, time and spatial perception deficits; depression and anxiety. Research also shows deficits in executive functioning skills like problem solving, attention, decision making and effective use of working memory.

Method: Brain MRI was done and 3D T1 images were obtained for neuronavigation. The navigated repetitive magnetic stimulation was administered over the left Dorsolateral Prefrontal Cortex (DLPFC) for 5 sessions/week x 2 weeks = 10 sessions. Each session was 15 minutes in duration. Twenty-five trains of rTMS (2s of 20Hz/train, 40 pulses/train) were provided. In total, the brain was stimulated with 1000 pulses over a period of 15 minutes. 54 IPD patients were recruited and randomized into the control (n=26) and intervention group (n=22). Patients in the control group were receiving traditional pharmacological treatment. Neuropsychological assessment was done at baseline, one-month post treatment, and three months post treatment.

Results: Analysis showed that rTMS brought about a beneficial impact on Depression (t1=0.006, t2=0.002), overall Depression Anxiety Stress Scale (DASS) score (t1=0.004, t2=0.002), Orientation (t1=0.001, t2=0.001), Memory (t1=0.001, t2=0.001), Executive functioning (t1=0.001, t2=0.006) at both time points, and Calculation at one time point (t1=0.001, t2=0.092) as compared to the control group.

Conclusion: The current rTMS protocol may be beneficial for the maintenance of neuropsychological functions in the domains of memory, executive functioning, calculation, depression, anxiety and stress of PD patients.

References: 1. GBD 2016 Parkinson’s Disease Collaborators (2018). Global, regional, and national burden of Parkinson’s disease, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. Neurology, 17(11), 939–953. https://doi.org/10.1016/S1474-4422(18)30295-3
2. India State-Level Disease Burden Initiative Neurological Disorders Collaborators (2021). The burden of neurological disorders across the states of India: the Global Burden of Disease Study 1990-2019. The Lancet. Global health, 9(8), e1129–e1144. https://doi.org/10.1016/S2214-109X(21)00164-9

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effectiveness-of-repetitive-transcranial-magnetic-stimulation-rtms-on-activities-of-daily-living-behavioural-and-cognitive-ability-a-b-c-of-pd-patients-a-randomized-controlled-trial/