Article

OBJECTIVE: To investigate the safety and efficacy of 50-Hz repetitive
transcranial magnetic stimulation (rTMS) in the treatment of motor symptoms in
Parkinson disease (PD). BACKGROUND: Progression of PD is characterized by the
emergence of motor deficits that gradually respond less to dopaminergic therapy.
rTMS has shown promising results in improving gait, a major cause of disability,
and may provide a therapeutic alternative. Prior controlled studies suggest that
an increase in stimulation frequency might enhance therapeutic efficacy. METHODS:
In this randomized, double blind, sham-controlled study, the authors investigated
the safety and efficacy of 50-Hz rTMS of the motor cortices in 8 sessions over 2
weeks. Assessment of safety and clinical efficacy over a 1-month period included
timed tests of gait and bradykinesia, Unified Parkinson's Disease Rating Scale
(UPDRS), and additional clinical, neurophysiological, and neuropsychological
parameters. In addition, the safety of 50-Hz rTMS was tested with
electromyography-electroencephalogram (EMG-EEG) monitoring during and after
stimulation. RESULTS: The authors investigated 26 patients with mild to moderate
PD: 13 received 50-Hz rTMS and 13 sham stimulation. The 50-Hz rTMS did not
improve gait, bradykinesia, and global and motor UPDRS, but there appeared a
short-lived "on"-state improvement in activities of daily living (UPDRS II). The
50-Hz rTMS lengthened the cortical silent period, but other neurophysiological
and neuropsychological measures remained unchanged. EMG/EEG recorded no
pathological increase of cortical excitability or epileptic activity. There were no adverse effects. CONCLUSION: It appears that 50-Hz rTMS of the motor cortices
is safe, but it fails to improve motor performance and functional status in PD.
Prolonged stimulation or other techniques with rTMS might be more efficacious but
need to be established in future research.

Langue : ANGLAIS