Objective: To evaluate the efficacy of high-frequency M1-rTMS for musculoskeletal pain in PD and investigate its underlying neurophysiological mechanisms using multimodal electrophysiology and imaging.
Background: Pain is a frequent and disabling non-motor symptom in Parkinson’s disease (PD), yet effective treatments remain limited. Repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex (M1) has shown analgesic potential in chronic pain, but its efficacy and neural mechanisms underlying pain in PD are not well understood.
Method: In this randomized, double-blind, sham-controlled trial, 62 PD patients with musculoskeletal pain received either active M1-rTMS (n=40) or sham stimulation (n=22) for seven consecutive days. Clinical outcomes were assessed up to 2 months. Resting-state EEG, TMS-EEG, and functional MRI were acquired to examine treatment-related changes in brain network dynamics, EEG microstates, spectral activity, and fractional amplitude of low-frequency fluctuations (fALFF). Mediation analyses were conducted to explore neural mechanisms underlying clinical response.
Results: Compared with sham stimulation, active M1-rTMS significantly reduced pain intensity and frequency and improved mood, sleep quality, and quality of life over the 2-month follow-up. Neurophysiological analyses revealed increased frontal information inflow in TMS-EEG networks, altered EEG microstate dynamics, reduced frontal gamma-band relative power, and decreased fALFF in the left insula. Changes in microstate class C time coverage and insular fALFF partially mediated the therapeutic effects of rTMS.
Conclusion: High-frequency M1-rTMS alleviates musculoskeletal pain in PD and induces coordinated reorganization of pain-related neural networks. These findings provide mechanistic evidence supporting M1-rTMS as a network-targeted neuromodulation strategy for pain management in PD.
To cite this abstract in AMA style:
C. Mao, M. Liu, Y. Luo, Y. Zhang, E. Wang, X. Cheng, J. Zhang, F. Wang, C. Liu. Neural Network Reorganization Mediates the Analgesic Effects of Repetitive Transcranial Magnetic Stimulation in Parkinson’s Disease [abstract]. Mov Disord. 2026; 41 (suppl 1). https://www.mdsabstracts.org/abstract/neural-network-reorganization-mediates-the-analgesic-effects-of-repetitive-transcranial-magnetic-stimulation-in-parkinsons-disease/. Accessed October 1, 2026.« Back to 2026 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/neural-network-reorganization-mediates-the-analgesic-effects-of-repetitive-transcranial-magnetic-stimulation-in-parkinsons-disease/