ABSTRACT
BACKGROUND: Transcranial magnetic stimulation (rTMS) may influence the progression of PD compared with levodopa. The long term mind modification effect of repeated rTMS and tDCS is not known, nor are the predictors for the effect of NBS. OBJECTIVE/HYPOTHESIS: We hypothesized that the regularly repeated rTMS would decrease the development of PD. Later, the treatment protocol was completed with transcranial direct current stimulation (tDCS), supposing that there is an add-on effect. NBS may differently influence motor and mental aspects of the disease. METHODS: Thirty patients with PD were followed for 3.5 years in an open study. They were stimulated with 1â¯Hz rTMS every half year for 1.5 years. After that the tDCS was add to the stimulation over both sides of the cerebellum for the next 2 years. UPDRS, Trail Making Test and dual tests were used. The linear regression lines of score systems and percentage of yearly increment were counted, analyzed by ANOVA. RESULTS: The yearly progression rate for UPDRS total was 2% for 3.5 years, 0.6% ≤65 years, 3.6% >65 years. The increment was around zero during the rTMSâ¯+â¯tDCS stimulations in patients ≤65 years. The slope of the equation showed the same tendency. The individual sensitivity to the NBS was high. tTMS and tDCS >65 yrs improved pathological executive function (pâ¯<â¯0.0001). CONCLUSION: The motor ability in PD was maintained at the same level in patients ≤65 years with NBS for the 3.5 years in contrast to patients >65 years. The cognitive function of patients >65 yrs was favorable influenced by rTMS and tDCS. Age is the main predictor of the effect of NBS. rTMS and tDCS can slow the progression of PD without any side effects but in an age-dependent way.
Subject(s)
Parkinson Disease/therapy , Transcranial Direct Current Stimulation , Transcranial Magnetic Stimulation , Age Factors , Aged , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Cognition , Disease Progression , Executive Function , Female , Follow-Up Studies , Humans , Male , Middle Aged , Motor Activity , Parkinson Disease/epidemiology , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Transcranial Direct Current Stimulation/methods , Transcranial Magnetic Stimulation/methods , Treatment OutcomeABSTRACT
BACKGROUND: rTMS may influence on both cognitive and motor function in PD but the daily routine and the predictors of responders to rTMS are not known. OBJECTIVE/HYPOTHESIS: We hypothesized that the frequency and intensity of stimulation somehow relate to each other. Our goal was to select the optimal frequency with low intensity for PD. We clarified the importance of age in the effect of rTMS. METHODS: A total sixty-six patients with PD were included in the study. In an open investigation, randomly selected patients were divided into three groups. The effects of 1Hz (N=28), 5Hz (N=13) and 5+1Hz (N=25) frequency at low intensity over each DLPFC and the brain stem for 7days were compared. Patients were followed for six months. UPDRS, the Trail Making Test, and dual tasks were applied. Patients ≤65years >65yrs were compared. Data were analyzed by repeated measure ANOVA. RESULTS: Only 1Hz had an effect on motor scores. Before the trial patients≤65 yrs had UPDRS total scores of 30.3±16.9, after 1 month: 17.8±8.9 p<0.001, after 6 months 18.3±8.8 p<0.001. Improvement of patients >65yrs was observed after one month (p<0.01). Executive function >65yrs (N=16) was significantly worse compared with C (N=15) and it was improved temporarily by 1Hz. Five Hertz and 5+1Hz did not cause improvement. CONCLUSION: One Hertz with proper intensity has a good outcome in PD. Patients >65yrs show deterioration in their executive function and they have shorter duration in their therapeutic effect of rTMS. This study draws attention to the importance of stimulation intensity and age as a predictor of the effect of rTMS.