Session Time: 1:45pm-3:15pm
Location: Hall 3FG
Objective: To evaluate the combined effect of repetitive transcranial magnetic stimulation (rTMS) on treadmill training in people with Parkinson’s disease (PD).
Background: Previous studies showed that motor learning can be augmented by high-frequency rTMS. In contrast, brain plasticity can also be improved by lowering the neuronal activity prior to training based on homeostatic plasticity. In people with PD, effect of treadmill training was enhanced by 5-Hz rTMS while priming effect of low-frequency rTMS in PD is unknown. Hence, it is unclear whether high- or low-frequency rTMS has a better priming effect on subsequent motor training in people with PD.
Methods: 45 participants with PD were randomized into 3 groups: 25-Hz, 1-Hz, and sham rTMS. 12 sessions of rTMS and treadmill training were performed over 3 weeks. 600 TMS stimuli at 80% resting motor threshold were delivered to leg area of motor cortex of each hemisphere. Behavioral assessment including MDS-UPDRS III and 10-meter walk test at fastest speed were used to evaluate the efficacy of combined rTMS and treadmill training. Two-way repeated measure ANOVA was used to evaluate the outcome data. SPSS 23.0 was used for all statistical analysis.
Results: There was a significant interaction effect on MDS-UPDRS III score (P<0.001) and a trend on fastest walking speed (P=0.064). Significant between-group differences for MDS-UPDRS III changes from baseline were found, with 25-Hz group having a greater reduction of MDS-UPDRS III score than sham group (P<0.001) and marginal significant difference compared to1-Hz group (P=0.057). The mean changes of the MDS-UPDRS III: 25-Hz =-8.3± 4.6, 1-Hz= -4.9± 2.6 and sham = -2.6±3.8. A trend of greater improvement in the fastest walking speed was found in 25-Hz vs. sham group (P=0.087). The mean changes for the walking speed: 25-Hz=14.7±11.0cms-1, 1-Hz=13.5±15.7cms-1 and sham=4.1±10.0cms-1.
Conclusions: Our results showed that combining both 1-Hz and 25-Hz rTMS with treadmill training improved motor sign and walking performance in people with PD. 25-Hz rTMS appears to have better effect than 1-Hz in the augmenting the effects of treadmill training. 25-Hz rTMS might enhance the corticomotor excitability for subsequent motor training.
References: Karabanov A, Ziemann U, Hamada M, et al.Consensus Paper: Probing Homeostatic Plasticity of Human Cortex: With Non-invasive Transcranial Brain Stimulation. Brain Stimul. 2015 Sep-Oct;8(5):993-1006. Yang YR, Tseng CY, Chiou SY et al. Combination of rTMS and treadmill training modulates corticomotor inhibition and improves walking in Parkinson’s disease: A randomized Trial. Neurorehabil Neural Repair. 2013 Jan;27(1):79-86.
To cite this abstract in AMA style:C. Chung, M. Mak, M. AuYeung, Y. Chan, N. Cheung, V. Mok, M. Hallett. The combined effect of repetitive transcranial magnetic stimulation and treadmill training in people with Parkinson’s disease – A randomized controlled trial [abstract]. Mov Disord. 2018; 33 (suppl 2). https://www.mdsabstracts.org/abstract/the-combined-effect-of-repetitive-transcranial-magnetic-stimulation-and-treadmill-training-in-people-with-parkinsons-disease-a-randomized-controlled-trial/. Accessed December 2, 2023.
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