Objective: To evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) with treadmill training on walking performance and corticomotor excitability in people with Parkinson’s disease (PD).

Background: Previous study showed that effect of treadmill training was enhanced by 5-Hz rTMS in people with PD. However, the mechanism underlying the improvement is unclear. It is also not known whether low-frequency rTMS produce a similar effect.

Methods: In a randomized placebo controlled study, we evaluated the effects of combined 25-Hz or 1-Hz rTMS and treadmill training on 7 subjects with PD. 12 sessions of rTMS and treadmill training were performed over a 3-week period. Leg area of bilateral motor cortex were stimulated with a total of 1200 pulses in each session. Stimulation intensity was set at 80% of resting motor threshold. All the participants proceeded to 30 minutes of treadmill training immediately after rTMS. The assessment included 7-meter instrumental timed up-and-go test (iTUG) single and dual task (iTUG_DT) conditions, 10-meter walk test at subjects’ fastest speed (10MWT) and cortical excitability using motor evoked potentials (MEPs) from the tibialis anterior.

Results: Three subjects received sham rTMS, 2 subjects received 25-Hz rTMS and 2 received 1-Hz rTMS. There is no significant between-group difference in the subject demographics in the baseline. Our results showed that the peak MEPs amplitude increased by 0.7±0.4 mV after 25-Hz rTMS and decreased by 0.9±0.6 mV after 1-Hz rTMS but there was minimal change in sham group (by 0.1±0.5 mV). The improvements in the iTUG (by -4.3±0.8s) and iTUG_DT (by-7.7±8.0s) were more prominent in 25-Hz group than 1-Hz group. When combining the 25-Hz and 1-Hz rTMS groups and compared with sham rTMS, results revealed that the real rTMS, but not sham had trend of improvement in 10MWT (p=0.07) and 7m-TUG_DT (p=0.07) with the intervention.

Conclusions: Our results suggest that the effects of treadmill training may be enhanced by rTMS. Corticomotor excitability measure seems to show differential effects with high- and low- frequency rTMS. More robust improvement in the motor performance in PD individuals was produced by priming treadmill training with 25-Hz rTMS. More subjects are required to conclude these results.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-combined-repetitive-transcranial-magnetic-stimulation-and-treadmill-training-on-gait-performance-in-parkinsons-disease/