Repetitive Transcranial Magnetic Stimulation Treatment For Parkinson's: Difference between revisions

No edit summary
No edit summary
Line 8: Line 8:


== Parkinson's Disease ==
== Parkinson's Disease ==
[https://www.physio-pedia.com/Parkinson%27s_Disease Parkinson disease] (PD) is a progressive neurodegenerative disorder caused by degradation of dopamine-producing cells in the Substantia Nigra Pars Compacta.<ref name=":0">Kalia L, Lang A. Parkinson's disease. LANCET. 2015; 386:896-912.</ref> The resulting decrease in dopamine produces motor symptoms characterized by resting tremor, bradykinesia, rigidity, mobilization difficulties, and [[balance]] deficits.<ref name=":1">Chou Y, Hickey PT, Sundman M, Song AW, Chen N. Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson Disease: A Systematic Review and Meta-analysis. JAMA Neurology. 2015; 72:432-440.</ref> In addition to motor symptoms, PD also includes non-motor symptoms including cognitive impairment, [[depression]], hallucinations, autonomic features and sleep problems.<ref name=":2">Williams-Gray CH, Worth PF. Parkinson's disease. ''Medicine''. 2016;44:542-546.</ref> PD affects all races and ethnicities, and it is estimated that 6-10 million people worldwide are afflicted by the disease.<ref name=":1" /> The incidence of PD ranges from 10–18 per 100 000 person-years, and increases rapidly with age, affecting approximately 2-3% of the population older than 65 years of age.<ref name=":0" /> Clinical Diagnosis of PD is based on the presence of typical parkisonian motor symptoms, including bradykinesia plus rigidity and resting tremor.<ref name=":0" /> Current medical therapy for PD only treats the symptoms of the disease, and primarily consists of medications which slow or stop the underlying neurodegenerative process.<ref name=":0" /> However it is reported that most patients develop complications after 5 years, including dyskinesia and motor fluctuations.<ref name=":2" /> Novel treatments of PD have been emerging over the past decades, including Transcranial Magnetic Stimulation (TMS) which has generated interest as a potential therapeutic intervention.<ref name=":1" />  
[https://www.physio-pedia.com/Parkinson%27s_Disease Parkinson's disease] (PD) is a progressive neurodegenerative disorder caused by degradation of dopamine-producing cells in the Substantia Nigra Pars Compacta.<ref name=":0">Kalia L, Lang A. Parkinson's disease. LANCET. 2015; 386:896-912.</ref> The resulting decrease in dopamine produces motor symptoms characterized by resting tremor, bradykinesia, rigidity, mobilization difficulties, and [[balance]] deficits.<ref name=":1">Chou Y, Hickey PT, Sundman M, Song AW, Chen N. Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson Disease: A Systematic Review and Meta-analysis. JAMA Neurology. 2015; 72:432-440.</ref> In addition to motor symptoms, PD also includes non-motor symptoms including cognitive impairment, [[depression]], hallucinations, autonomic features and sleep problems.<ref name=":2">Williams-Gray CH, Worth PF. Parkinson's disease. ''Medicine''. 2016;44:542-546.</ref> PD affects all races and ethnicities, and it is estimated that 6-10 million people worldwide are afflicted by the disease.<ref name=":1" /> The incidence of PD ranges from 10–18 per 100 000 person-years, and increases rapidly with age, affecting approximately 2-3% of the population older than 65 years of age.<ref name=":0" /> Clinical Diagnosis of PD is based on the presence of typical parkisonian motor symptoms, including bradykinesia plus rigidity and resting tremor.<ref name=":0" /> Current medical therapy for PD only treats the symptoms of the disease, and primarily consists of medications which slow or stop the underlying neurodegenerative process.<ref name=":0" /> However it is reported that most patients develop complications after 5 years, including dyskinesia and motor fluctuations.<ref name=":2" /> Novel treatments of PD have been emerging over the past decades, including Transcranial Magnetic Stimulation (TMS) which has generated interest as a potential therapeutic intervention.<ref name=":1" />  


== Transcranial Magnetic Stimulation (TMS) ==
== Transcranial Magnetic Stimulation (TMS) ==
Line 27: Line 27:


== Additional Resources ==
== Additional Resources ==
* [https://www.physio-pedia.com/Parkinson%27s_Disease Parkinson disease]
* [https://www.physio-pedia.com/Parkinson%27s_Disease Parkinson's Disease]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Clinical_Presentation]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Clinical_Presentation Parkinson's Disease - Clinical Presentation]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Anatomy,_Pathology,_Prognosis_and_Diagnosis]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Anatomy,_Pathology,_Prognosis_and_Diagnosis Parkinson's Disease - Anatomy, Pathology, Prognosis, and Diagnosis]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Physiotherapy_Referral_and_Assessment]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Physiotherapy_Referral_and_Assessment Parkinson's Disease - Physiotherapy Referral and Assessment]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Physiotherapy_Management_and_Interventions]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Physiotherapy_Management_and_Interventions Parkinson's Disease - Physiotherapy Management and Interventions]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Outcome_Measures]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Outcome_Measures Parkinson's Disease - Outcome Measures]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Key_Evidence_and_resources]
* [https://www.physio-pedia.com/Parkinson%27s_Disease_-_Key_Evidence_and_resources Parkinson's Disease - Key Evidence and Resources]


== References ==
== References ==

Revision as of 18:13, 9 May 2018


Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Hunter Fassett, Pacifique Dusabeyezu, Jordan Moulaison, Mitchell Brenton, Kim Jackson, Joshua Hunter, Lauren Lopez, Matthew Smorenburg, Vidya Acharya, Angeliki Chorti and Tolulope Adeniji  

Parkinson's Disease[edit | edit source]

Parkinson's disease (PD) is a progressive neurodegenerative disorder caused by degradation of dopamine-producing cells in the Substantia Nigra Pars Compacta.[1] The resulting decrease in dopamine produces motor symptoms characterized by resting tremor, bradykinesia, rigidity, mobilization difficulties, and balance deficits.[2] In addition to motor symptoms, PD also includes non-motor symptoms including cognitive impairment, depression, hallucinations, autonomic features and sleep problems.[3] PD affects all races and ethnicities, and it is estimated that 6-10 million people worldwide are afflicted by the disease.[2] The incidence of PD ranges from 10–18 per 100 000 person-years, and increases rapidly with age, affecting approximately 2-3% of the population older than 65 years of age.[1] Clinical Diagnosis of PD is based on the presence of typical parkisonian motor symptoms, including bradykinesia plus rigidity and resting tremor.[1] Current medical therapy for PD only treats the symptoms of the disease, and primarily consists of medications which slow or stop the underlying neurodegenerative process.[1] However it is reported that most patients develop complications after 5 years, including dyskinesia and motor fluctuations.[3] Novel treatments of PD have been emerging over the past decades, including Transcranial Magnetic Stimulation (TMS) which has generated interest as a potential therapeutic intervention.[2]

Transcranial Magnetic Stimulation (TMS)[edit | edit source]

Transcranial magnetic stimulation (TMS) was developed in 1985 by Barker and colleagues which allowed them to non-invasively stimulate areas of the human cortex of the brain.[4] Since then, this technology has developed and found a place in both clinical research and treatment of various populations such as those experiencing mood[5] or movement disorders [6]. This modality is comprised of numerous conductive wires wrapped together into a circular coil within a hard plastic housing. By passing a brief electric pulse through these coil windings, a magnetic field is generated perpendicular to the coil which passes relatively unimpeded through the scalp and skull when placed on the head. This magnetic pulse, by the principles of electromagnetism, produce secondary electric fields in the opposite direction to the field generated by the coil.[4][7][8][9] It is these secondary fields that influence any conductive material or tissue in the path of the magnetic field. In this case, that conductive tissue is neurons within the cortex of the brain. Using the above phenomenon, TMS can be used to stimulate or excite regions of the cortex to probe the function of various brain regions and their interactions.[2][9][10]

Types of TMS[edit | edit source]

  1. Single pulse TMS can be used to simply stimulate a given area while recording the output and is commonly used in research where an area such as the motor cortex is stimulated and a motor response can be recorded from muscles of the body via electromyography.[7][9]
  2. Paired-pulse TMS can be used to assess the effect of a preceding stimulus on a secondary stimulus.[11] While this technique is also primarily used in research, it allows for the assessment of one brain region on another. For example, a TMS pulse delivered to the motor cortex of one hemisphere of the brain 10ms prior to a TMS pulse delivered over the opposite motor cortex results in an inhibitory effect in motor output to the arms, showing firing patterns that allow for unimanual control of the upper limbs.[12][13]
  3. Repetitive TMS (rTMS) techniques involve stringing a large number of consecutive TMS pulses together in rapid succession. This method is used both in research and clinically as it can produce changes in cortical activity that last beyond the duration of the TMS protocol.[2][10][14] With some reports demonstrating excitability changes persisting for a number of hours[15]. The rate of pulse delivery appears to dictate the effect of the rTMS protocol, whereas those that deliver pulses at rates of >5Hz (high frequency rTMS) tend to produce excitatory effects and those delivered at rates of < 1Hz (low frequency rTMS) tend to produce inhibitory effects in the brain.[8][10]. These rTMS techniques have been approved as a treatment modality for those with non-responsive major depression disorder (MDD) in Canada.[5] While the use of rTMS has not yet been approved for clinical use in the treatment of movement disorders such as stroke, spinal cord injury,, and PD, the scientific literature suggests that it may provide some benefit to both motor and cognitive symptoms in these populations.[6][16][17][18]

Potential Benefits of RTMS for Individuals with Parkinson's Disease[edit | edit source]

Motor Benefits[edit | edit source]

Recent studies have shown that rTMS has a positive effect on motor functioning in patients with PD. Specifically, gait performance (kinematics measured via force platform, accelerometers or 3D motion capture) and UPDRS III scores (SMD = 0.39-0.46) improved with rTMS treatment compared to sham stimulation.[2][18][19] One meta-analysis found that the mean change in UPDRS III scores with rTMS treatment was -6.42 points,[2] corresponding to a clinically significant change.[20] These changes appear to depend on the location of rTMS stimulation, whereby high frequency rTMS over the primary motor cortex and low frequency rTMS over the supplementary motor area both resulted in motor symptom improvements (i.e., bradykinesia, resting tremor, rigidity, postural instability, and levodopa-induced dyskinesia).[2][18] rTMS treatment showed no significant effects of medication (SMD = 0.326 vs. 0.510; ON vs. OFF, p = 0.570) or disease severity (SMD = 0.668 vs. 0.501 vs. 0.782; mild vs. moderate vs. severe, p = 0.876).[18] This suggests that rTMS may be an effective treatment for management of motor symptoms regardless of medication or disease severity.

Cognitive Benefits[edit | edit source]

A study conducted by Moisello et al. (2015) found that high frequency rTMS over the primary motor cortex enhanced retention of a visuo-motor skill (target reaching using proprioceptive cues) and memory consolidation in patients with PD.[21] Further, it has been shown that patients with PD receiving high frequency rTMS showed improved performance on the Stroop and Hooper and Wisconsin Tests, indicating that rTMS may help PD with dual-tasking and attention.[22] However, rTMS does not appear to have pronounced effects on other executive functions (e.g., visuospatial abilities, psychomotor speed) compared to sham stimulation although very limited study in this area has been conducted to date.[18]

Additional Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Kalia L, Lang A. Parkinson's disease. LANCET. 2015; 386:896-912.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Chou Y, Hickey PT, Sundman M, Song AW, Chen N. Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson Disease: A Systematic Review and Meta-analysis. JAMA Neurology. 2015; 72:432-440.
  3. ↑ 3.0 3.1 Williams-Gray CH, Worth PF. Parkinson's disease. Medicine. 2016;44:542-546.
  4. ↑ 4.0 4.1 Barker AT, Jalinous R, Freeston IL. NON-INVASIVE MAGNETIC STIMULATION OF HUMAN MOTOR CORTEX. The Lancet. 1985;325:1106-1107.
  5. ↑ 5.0 5.1 Downar J, Blumberger D, Daskalakis Z. Repetitive transcranial magnetic stimulation: an emerging treatment for medication-resistant depression. CANADIAN MEDICAL ASSOCIATION JOURNAL. 2016;188:1175-1177.
  6. ↑ 6.0 6.1 Ni Z, Chen R. Transcranial magnetic stimulation to understand pathophysiology and as potential treatment for neurodegenerative diseases. Translational neurodegeneration. 2015 Dec;4(1):22.
  7. ↑ 7.0 7.1 Hallett M. Transcranial magnetic stimulation and the human brain. Nature. 2000;406:147-150.
  8. ↑ 8.0 8.1 Hallett M. Transcranial Magnetic Stimulation: A Primer. Neuron. 2007;55:187-199.
  9. ↑ 9.0 9.1 9.2 Siebner H, Rothwell J. Transcranial magnetic stimulation: new insights into representational cortical plasticity. Experimental Brain Research. 2003;148:1-16.
  10. ↑ 10.0 10.1 10.2 Rossini PM, Burke D, Chen R, et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clinical Neurophysiology. 2015;126:1071-1107
  11. ↑ Chen R. Interactions between inhibitory and excitatory circuits in the human motor cortex. Experimental Brain Research. 2004;154:1-10.
  12. ↑ Ni Z, Gunraj C, Nelson AJ, et al. Two Phases of Interhemispheric Inhibition between Motor Related Cortical Areas and the Primary Motor Cortex in Human. Cerebral Cortex. 2009;19:1654-1665.
  13. ↑ Ferbert A, Priori A, Rothwell JC, Day BL, Colebatch JG, Marsden CD. Interhemispheric inhibition of the human motor cortex. The Journal of Physiology. 1992;453:525-546
  14. ↑ Chung SW, Rogasch NC, Hoy KE, Fitzgerald PB. Measuring Brain Stimulation Induced Changes in Cortical Properties Using TMS-EEG. Brain Stimulation. 2015;8:1010-1020.
  15. ↑ Huang Y-Z, Edwards MJ, Rounis E, Bhatia KP, and Rothwell JC. Theta Burst Stimulation of the Human Motor Cortex. Neuron 45: 201-206, 2005.
  16. ↑ Le Q, Qu Y, Tao Y, Zhu S. Effects of repetitive transcranial magnetic stimulation on hand function recovery and excitability of the motor cortex after stroke: a meta-analysis. American journal of physical medicine & rehabilitation. 2014 May 1;93(5):422-30.
  17. ↑ Tazoe T, Perez MA. Effects of repetitive transcranial magnetic stimulation on recovery of function after spinal cord injury. Archives of physical medicine and rehabilitation. 2015 Apr 1;96(4):S145-55.
  18. ↑ 18.0 18.1 18.2 18.3 18.4 Goodwill A, Lum J, Hendy A, et al. Using non-invasive transcranial stimulation to improve motor and cognitive function in Parkinson's disease: a systematic review and meta-analysis. SCIENTIFIC REPORTS. 2017;7.
  19. ↑ Lefaucheur J, André-Obadia N, Antal A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology. 2014;125:2150-2206.
  20. ↑ Shulman LM, Gruber-Baldini AL, Anderson KE, Fishman PS, Reich SG, Weiner WJ. The Clinically Important Difference on the Unified Parkinson's Disease Rating Scale. Archives of Neurology. 2010;67:64-70.
  21. ↑ Moisello C, Blanco D, Fontanesi C, et al. TMS Enhances Retention of a Motor Skill in Parkinson's Disease. Brain Stimulation. 2015;8:224-230.
  22. ↑ Boggio PS, Fregni F, Bermpohl F, et al. Effect of repetitive TMS and fluoxetine on cognitive function in patients with Parkinson's disease and concurrent depression. Movement Disorders. 2005;20:1178-1184.
Retrieved from "https://www.physio-pedia.com/index.php?title=Repetitive_Transcranial_Magnetic_Stimulation_Treatment_For_Parkinson%27s&oldid=188114"