Chloe Lau-Ha Chung1, Margaret Kit-Yi Mak1, Mark Hallett2. 1. Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong. 2. Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
Abstract
OBJECTIVE: To determine whether priming with 1 or 25Hz repetitive transcranial magnetic stimulation (rTMS) will enhance the benefits from treadmill training up to 3 months postintervention in people with Parkinson disease (PD), and to evaluate the underlying changes in cortical excitability. METHODS: This randomized double-blind, placebo-controlled trial was conducted between October 2016 and December 2018. Fifty-one participants with PD were randomized to receive 12 sessions of rTMS (25Hz, 1Hz, or sham) followed by treadmill training. All participants were assessed at baseline and 1 day, 1 month, and 3 months postintervention. Primary outcome was fastest walking speed, and secondary outcomes were timed up-and-go test (TUG), dual-task TUG (DT-TUG), motor section of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III), and electrophysiological evaluation of cortical excitability by TMS. RESULTS: The 1 and 25Hz rTMS groups produced a greater improvement in fastest walking speed at 1 day and 3 months postintervention than the sham group. Only the 1 and 25Hz rTMS groups sustained the improvements in TUG, and had a significant improvement in DT-TUG and MDS-UPDRS-III for up to 3 months. Behavioral improvements correlated with increased cortical silent period and short-interval intracortical inhibition in both groups receiving real rTMS. INTERPRETATION: Priming with 1 and 25Hz rTMS can augment the benefits of treadmill training and lead to long-term motor improvement up to 3 months postintervention. The motor improvement at follow-up was associated with a normalization of cortical excitability, which in turn suggests an alteration of the homeostatic plasticity range. Rebalancing cortical excitability by rTMS appears critical for plasticity induction. ANN NEUROL 2020;88:933-945.
OBJECTIVE: To determine whether priming with 1 or 25Hz repetitive transcranial magnetic stimulation (rTMS) will enhance the benefits from treadmill training up to 3 months postintervention in people with Parkinson disease (PD), and to evaluate the underlying changes in cortical excitability. METHODS: This randomized double-blind, placebo-controlled trial was conducted between October 2016 and December 2018. Fifty-one participants with PD were randomized to receive 12 sessions of rTMS (25Hz, 1Hz, or sham) followed by treadmill training. All participants were assessed at baseline and 1 day, 1 month, and 3 months postintervention. Primary outcome was fastest walking speed, and secondary outcomes were timed up-and-go test (TUG), dual-task TUG (DT-TUG), motor section of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III), and electrophysiological evaluation of cortical excitability by TMS. RESULTS: The 1 and 25Hz rTMS groups produced a greater improvement in fastest walking speed at 1 day and 3 months postintervention than the sham group. Only the 1 and 25Hz rTMS groups sustained the improvements in TUG, and had a significant improvement in DT-TUG and MDS-UPDRS-III for up to 3 months. Behavioral improvements correlated with increased cortical silent period and short-interval intracortical inhibition in both groups receiving real rTMS. INTERPRETATION: Priming with 1 and 25Hz rTMS can augment the benefits of treadmill training and lead to long-term motor improvement up to 3 months postintervention. The motor improvement at follow-up was associated with a normalization of cortical excitability, which in turn suggests an alteration of the homeostatic plasticity range. Rebalancing cortical excitability by rTMS appears critical for plasticity induction. ANN NEUROL 2020;88:933-945.
Authors: Freek Nieuwhof; Bastiaan R Bloem; Miriam F Reelick; Esther Aarts; Inbal Maidan; Anat Mirelman; Jeffrey M Hausdorff; Ivan Toni; Rick C Helmich Journal: Brain Date: 2017-05-01 Impact factor: 13.501
Authors: Stephanie Studenski; Subashan Perera; Kushang Patel; Caterina Rosano; Kimberly Faulkner; Marco Inzitari; Jennifer Brach; Julie Chandler; Peggy Cawthon; Elizabeth Barrett Connor; Michael Nevitt; Marjolein Visser; Stephen Kritchevsky; Stefania Badinelli; Tamara Harris; Anne B Newman; Jane Cauley; Luigi Ferrucci; Jack Guralnik Journal: JAMA Date: 2011-01-05 Impact factor: 56.272
Authors: S Groppa; A Oliviero; A Eisen; A Quartarone; L G Cohen; V Mall; A Kaelin-Lang; T Mima; S Rossi; G W Thickbroom; P M Rossini; U Ziemann; J Valls-Solé; H R Siebner Journal: Clin Neurophysiol Date: 2012-02-19 Impact factor: 3.708