Objective: To investigate whether intermittent Theta Burst Trans Spinal Magnetic Stimulation(iTB–TsMS) enhance treadmill training benefit on gait function, freezing of gait(FoG), other motor symptoms and quality of life(QoL) in people with PD.

Background: Gait disorders are a major cause of disability in Parkinson’s disease (PD),^1,2appearing early and progressively worsening.³

Method: This randomized, parallel, double-blind, controlled, multicenter trial was conducted across three research centers in Brazil between October 2022 and May 2024. Participants were adults with PD, aged 18 or older, experiencing gait impairments but able to walk 30 meters. They underwent 10 sessions of iTB–TsMS or sham stimulation, administered five days per week for two weeks, followed by 30 minutes of treadmill training. The primary outcome was the change in fast gait speed(FGS)⁴ from baseline. Secondary outcomes included MDS-UPDRS parts II and III, comfortable gait speed(CGS)⁴, Timed Up and Go test(TUG)⁵ and Dual Task variant(TUG-DT)⁶, Mini-BESTest^7,8, 2-Minute Walk Test(2MWT)⁹, Freezing of Gait questionnaire(FoG-Q)¹⁰ and FoG-Score¹¹, 360° turn test¹², PDQ-39¹³, Falls Efficacy Scale-International(FES-I)¹⁴, falls, and near-falls. Assessments occurred at baseline(T0) and post-intervention at 3(T3), 15(T15), 30(T30), and 90(T90) days.

Results: Seventy participants were analyzed. The median age was 62 years(IQR: 55–69) in the active group and 59 years(IQR: 55–65) in the sham group; 21(62%) in the active group and 27(75%) in the sham group were male. Significant between-group differences were observed at T3 in FGS[0.13(0.05–0.21),p=0.001,primary outcome], MDS-UPDRS II(p=0.040), FoG-Score(p=0.046), and near-falls(p=0.004). Differences in FoG-Q were found at T15[-1.46(-2.93–0.00),p=0.050], T30[-2.30(-3.77–-0.83),p=0.002], and T90[-1.75 (-3.22–-0.29), p=0.019], as well as in PDQ-39 mobility at T30(p=0.018). Other variables showed no significant changes. No significant differences in intervention-related side effects were found between groups(p=0.413). Mild and transient adverse events were reported by 10(29%) participants in the active group and 7(20%) in the sham group.

Conclusion: In individuals with PD and gait impairments, iTB-TsMS combined with TT improved gait speed, alleviated FOG and near-falls, and reduced the impact of motor symptoms on daily life compared to TT alone. The protocol was safe and well-tolerated.

Demographics and Baseline Characteristics

Outcomes by Visit and Comparisons Between Groups

Adverse Events

Longitudinal Effects of Active vs. Sham iTB- TsMS

References: 1. Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008;79(4):368-376. doi:10.1136/jnnp.2007.131045
2. Nisenzon AN, Robinson ME, Bowers D, Banou E, Malaty I, Okun MS. Measurement of patient-centered outcomes in Parkinson’s disease: What do patients really want from their treatment? Parkinsonism Relat Disord. 2011;17(2):89-94. doi:10.1016/j.parkreldis.2010.09.005
3. Galna B, Lord S, Burn DJ, Rochester L. Progression of gait dysfunction in incident Parkinson’s disease: Impact of medication and phenotype. Movement Disorders. 2015;30(3):359-367. doi:10.1002/mds.26110
4. Lang JT, Kassan TO, Devaney LL, Colon-Semenza C, Joseph MF. Test-retest reliability and minimal detectable change for the 10-meter walk test in older adults with Parkinson’s disease. Journal of Geriatric Physical Therapy. 2016;39(4):165-170. doi:10.1519/JPT.0000000000000068
5. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Timed “Up & Go” test in people with Parkinson disease. Phys Ther. 2001;81(2):810-818. doi:10.1093/ptj/81.2.810
6. Johansson H, Peterson DS, Sedhed J, Leavy B. Dual-task performance during the Timed Up and Go test in Parkinson’s disease – the impact of freezing and cognition. Gait Posture. 2025;115:14-20. doi:10.1016/j.gaitpost.2024.10.016
7. Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the balance evaluation systems test: The mini-bestest. J Rehabil Med. 2010;42(4):323-331. doi:10.2340/16501977-0537
8. Lopes LKR, Scianni AA, Lima LO, de Carvalho Lana R, Rodrigues-De-Paula F. The Mini-BESTest is an independent predictor of falls in Parkinson Disease. Braz J Phys Ther. 2020;24(5):433-440. doi:10.1016/j.bjpt.2019.07.006
9. Scaldaferri MEF, de Souza SAF, de Oliveira ÉRM, Ribeiro IL, Scianni AA, Faria CDC de M. Validity of the 2-minute walk test to Assess Exercise Capacity In Individuals With Parkinson Disease. Braz J Phys Ther. 2024;28:100912. doi:10.1016/j.bjpt.2024.100912
10. Baggio JAO, Curtarelli MB, Rodrigues GR, Tumas V. Validity of the Brazilian version of the freezing of gait questionnaire. Arq Neuropsiquiatr. 2012;70(8):599-603. doi:10.1590/S0004-282X2012000800008
11. Fietzek UM, Schulz SJ, Ziegler K, Ceballos-Baumann AO. The Minimal Clinically Relevant Change of the FOG Score. J Parkinsons Dis. 2020;10(1):325-332. doi:10.3233/JPD-191783
12. Soke F, Guclu-Gunduz A, Ozkan T, Ozkul C, Gulsen C, Kocer B. Reliability and validity of the timed 360° turn test in people with Parkinson’s disease. Eur Geriatr Med. 2020;11(3):417-426. doi:10.1007/s41999-019-00285-y
13. Peto V. Determining minimally important differences for the PDQ-39 Parkinson’s disease questionnaire. Age Ageing. 2001;30(4):299-302. doi:10.1093/ageing/30.4.299
14. Mehdizadeh M, Martinez-Martin P, Habibi SA, et al. Reliability and validity of fall efficacy scale-international in people with Parkinson’s disease during on- And off-drug phases. Parkinsons Dis. 2019;2019. doi:10.1155/2019/6505232

« Back to 2025 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/trans-spinal-theta-burst-magnetic-stimulation-enhances-treadmill-training-effects-on-gait-in-parkinsons-disease/