Session Information
Date: Wednesday, September 25, 2019
Session Title: Non-Pharmacological Interventions
Session Time: 1:15pm-2:45pm
Location: Les Muses Terrace, Level 3
Objective: To compare the clinical and neurophysiological effects of EEG guided Neurofeedback (NFB) vs 10Hz rTMS vs combined therapy (NFB+rTMS) in motor cortex of non-demented HY I-III PD patients
Background: rTMS has been shown in several studies to produce significant reduction in PD motor scores and increase of cortical silent period (CSP) when administered at high frequencies in M1[1,2,3], but its effects have not been long lasting. To our knowledge there are not studies comparing its effects with NFB nor testing a combined protocol of both techniques
Method: 30 non demented PD divided in 3 groups (no differences in sex (χ2(2)=0.2; p=0.89), age (F(2,31)= 0.07; p=0.932) or education (F(2,31)= 0,73; p=0.491),). UPDRS III 15,94±7,03 (SD), 598±315mg LED/day. rTMS group received 8 daily bilateral sessions 2000 pulses 10Hz 80%RMT. 5 min interval between hemispheres. NFB group received 8 30 minute sessions of visual feedback using 3D virtual reality oculus® googles (goal: increase in average alpha and beta frequency in 6 central EEG derivations). Combined therapy group received 8 sessions of rTMS followed by NFB protocol the same day. UPDRSIII and CSP were measured pre- intervention (A), after the completion of the protocol(B) and 15 days after completing the protocol (C).
Results: There was a reduction of UPDRS III scores in the combined group (F (2.18) = 15.38, p <0.001) between measurement A and B (μA-μB = -4.90, p = 0.001 ), which was maintained in C (μA-μC = -4.40, p = 0.014). In the rTMS group there was a reduction of the UPDRS III scores (F (2.20) = 2.44, p = 0.112) between measurement A and C (μA-μC = -4.63, p = 0.038). The NFB group did not register any improvement. CSP increased in both hemispheres significantly only in the combined group between A and B. Right hemisphere (F (2,18) = 2,393; p = 0.079); (μA-μB = -0,039; p = 0.023 ). Left hemisphere (F (2.18) = 5.53, p = 0.013) (μA-μB = -0, 039, p = 0.034).
Conclusion: Motor and neurophysiological effects of NFB alone are not comparable to rTMS, but it seems that priming the NFB training with rTMS M1 pre activation results in long lasting significant motor improvement in PD patients. This protocol shows promising effects of combining rTMS with a non-invasive and highly accessible technique that can prolong its effects having a real impact in treatment of motor symptoms of the disease.
References: 1 Lefaucheur, et al. (2004). “Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson’s disease”. Clinical Neurophysiology, 115(11), 2530-2541. 2 Maruo, et al. (2013). “High-Frequency Repetitive Transcranial Magnetic Stimulation over the Primary Foot Motor Area in Parkinson’s Disease”. Brain Stimulation, 6(6), 884-891. 3 Aftanas, et al (2018). “Therapeutic Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Neuroinflammation and Neuroplasticity in Patients with Parkinson’s Disease: a Placebo-Controlled Study”. Bulletin of Experi
To cite this abstract in AMA style:
J. Romero, A. Arroyo, J. Andreo, M. Del Castillo, J. Serrano, E. Rocon, N. Malpica, E. Melero, E. Sanz, M. Gil, E. Rodriguez. EEG guided neurofeedback boosts effects of motor cortex neuromodulation of rTMS in Parkinson´s Disease Patients [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/eeg-guided-neurofeedback-boosts-effects-of-motor-cortex-neuromodulation-of-rtms-in-parkinsons-disease-patients/. Accessed June 15, 2025.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/eeg-guided-neurofeedback-boosts-effects-of-motor-cortex-neuromodulation-of-rtms-in-parkinsons-disease-patients/