Objective: To explore whether the therapy of repetitive transcranial magnetic stimulation (rTMS) combined with lidocaine injection (rTMS-LI) just after rTMS has a modifying or a curative effect on dystonia.

Background: We reported an acute effect of rTMS (0.2 Hz over the premotor cortex, 250 stimuli per one session; Murase N et al., 2005) on writer’s cramp. Lidocaine injection with dehydrated ethanol was also effective on writer’s cramp based on the function of the block of sensory afferent fibers in muscle spindles (Muscle afferent block (MAB): Kaji R et al., 1995). Because rTMS retained its effect longer in the patients who had already been treated by MAB than in the treatment-naïve patients in the preliminary trials, we began to try rTMS-LI therapy, expecting the long-term effect, probably based on the similar mechanism of phase-dependent plasticity from premotor cortex followed by peripheral sensory input. The randomized controlled trial for six months-repeated therapy to compare the effect of rTMS-LI with botulinum neurotoxin (BoNT) and MAB, unveiled almost the same long-term effect of rTMS-LI with BoNT than MAB (n = 109; in preparation). Then to explore whether the rTMS-LI for dystonia has a modifying or a curative effect, we observed the patients with repeated rTMS-LI therapy for more than four years.

Method: Six dystonia patients (one upper limb dystonia, three writer’s cramp, one musician’s cramp, one Meige syndrome) who showed long-term rTMS-LI effect were enrolled (mean age 34.2 (SD 7.6) years old, disease duration 4.5 (2.29 years). rTMS-LI was administered monthly and originally modified BFM scale was used. The follow-up period was from four to twenty-one years (10.0 (6.3)). This is the single trial open-label study.

Results: All the patients without one showed sable improvement by the long-term repeated rTMS-LI and the modified BFM scale improved from 5.5 (3.1) before to 2.2 (0.7) after in the best condition. However, there were no patients who showed complete remission. One male patient showed marked worsening when he got promoted and overworked. He then gained complete remission by ablation surgery.

Conclusion: Monthly therapy of rTMS-LI has a modifying but not a curative effect on dystonia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/modifying-effect-of-a-long-term-repeated-therapy-of-repetitive-transcranial-magnetic-stimulation-combined-with-lidocaine-injection-rtms-li-on-dystonia/