Objective: To evaluate the role of rTMS over primary motor area, premotor area, supplementary motor area in Parkinsons Disease.

Background: Parkinson’s disease (PD) presents with characteristic motor symptoms such as tremor, rigidity, bradykinesia, problems with gait. The benefits of available standalone pharmacotherapy in managing the symptoms of PD wane off eventually; compromising the quality of life. We evaluated if neuromodulation by repetitive transcranial magnetic stimulation (rTMS) at three cortical foci alleviate the severity of motor symptoms of medicated PD patients of northern India.

Methods: Patients with PD presenting to the outpatient department and meeting the clinical inclusion criteria were enrolled in the randomized, single blind, sham-controlled, prospective study after obtaining due informed consent. The patients were randomly assigned to one of three groups (Motor area (M1), n=13; Premotor area (PMA), n = 18; Supplementary Motor area (SMA), n =19). All subjects received 4 sessions (once per week) of Sham stimulation followed by 4 sessions (once per week) of real stimulation. During each session subjects received 3000 stimulations at 1 Hz (at M1), 1 Hz (at PMA) and 5 Hz (at SMA).Sham TMS was given under identical settings as real rTMS with a sham coil. Stimulation and evaluation were both done during ON phase. The primary outcome measures were change of scores [validated clinical scales: UPDRS, PDQ39, HAMA, HAMD, Purdue Peg Board (PPB)] from baseline after sham and real rTMS.

Results: Comparisons between three groups (cortical foci) yielded significant improvements after real TMS compared to sham as reflected by UPDRS II (p=0.002), UPDRS III (p=0.002) and PDQ39 [Mobility (p=0.006) ADL (p=0.012)], PPB Right (p=0.001), PPB Left (p=0.003), PPB Assembly(p<0.001). These improvements were notable in M1 and SMA groups but not in PMA.

Conclusions: Treatment by rTMS over M1 and SMA offered significant clinical benefits as compared to pharmacotherapy alone. As there is evidence of geographic and ethnic trends in PD distribution, the present results suggest improvements in PD patients of the studied population. This merits detailed investigation of rTMS with a larger sample size and longer follow up in this patient pool.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effects-of-rtms-on-three-cortical-areas-in-parkinsons-disease/