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document
Intermittent theta-burst transcranial magnetic stimulation for treatment of Parkinson disease . OBJECTIVE To investigate the safety and efficacy of intermittent theta-burst stimulation ( iTBS ) in the treatment of motor symptoms in Parkinson disease ( PD ) . BACKGROUND Progression of PD is characterized by the emergence of motor deficits , which eventually respond less to dopaminergic therapy and pose a therapeutic challenge . Repetitive transcranial magnetic stimulation ( rTMS ) has shown promising results in improving gait , a major cause of disability , and may provide a therapeutic alternative . iTBS is a novel type of rTMS that may be more efficacious than conventional rTMS . METHODS In this randomized , double-blind , sham-controlled study , we investigated safety and efficacy of iTBS of the motor and dorsolateral prefrontal cortices in 8 sessions over 2 weeks ( evidence Class I ) . Assessment of safety and clinical efficacy over a 1-month period included timed tests of gait and bradykinesia , Unified Parkinson 's Disease Rating Scale ( UPDRS ) , and additional clinical , neuropsychological , and neurophysiologic measures . RESULTS We investigated 26 patients with mild to moderate PD : 13 received iTBS and 13 sham stimulation . We found beneficial effects of iTBS on mood , but no improvement of gait , bradykinesia , UPDRS , and other measures . EEG/EMG monitoring recorded no pathologic increase of cortical excitability or epileptic activity . Few reported discomfort or pain and one experienced tinnitus during real stimulation . CONCLUSION iTBS of the motor and prefrontal cortices appears safe and improves mood , but failed to improve motor performance and functional status in PD . CLASSIFICATION OF EVIDENCE This study provides Class I evidence that iTBS was not effective for gait , upper extremity bradykinesia , or other motor symptoms in PD .
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Intervention_Physical
Intermittent theta-burst transcranial magnetic stimulation
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Intervention_Physical
intermittent theta-burst stimulation ( iTBS )
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Intervention_Physical
Repetitive transcranial magnetic stimulation ( rTMS )
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Intervention_Physical
iTBS
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Intervention_Physical
rTMS
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Intervention_Physical
rTMS
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Intervention_Physical
iTBS
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Intervention_Physical
iTBS
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Intervention_Physical
sham stimulation
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Intervention_Physical
iTBS
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Intervention_Physical
iTBS
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Intervention_Physical
iTBS
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Outcome_Physical
Parkinson disease
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Outcome_Other
safety and efficacy
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Outcome_Physical
motor symptoms in Parkinson disease ( PD )
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Outcome_Physical
improving gait
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Outcome_Physical
disability
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Outcome_Other
safety and clinical efficacy
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Outcome_Physical
gait and bradykinesia
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Outcome_Mental
Unified Parkinson 's Disease Rating Scale ( UPDRS )
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Outcome_Mental
additional clinical
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Outcome_Mental
neuropsychological
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Outcome_Mental
neurophysiologic measures
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Outcome_Mental
mood
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Outcome_Physical
gait
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Outcome_Physical
bradykinesia
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Outcome_Physical
UPDRS
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Outcome_Mental
EEG/EMG
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Outcome_Physical
increase of cortical excitability
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Outcome_Physical
epileptic activity
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Outcome_Pain
discomfort or pain
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Outcome_Adverse-effects
tinnitus
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Outcome_Other
safe
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Outcome_Mental
improves mood
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Outcome_Physical
motor performance and functional status
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Outcome_Other
effective
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Outcome_Physical
gait
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Outcome_Physical
upper extremity bradykinesia
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Outcome_Physical
other motor symptoms in PD
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Participant_Condition
Parkinson disease .
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Participant_Sample-size
26
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Participant_Condition
PD