Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Japan.
Neurology. 2013 Apr 9;80(15):1400-5. doi: 10.1212/WNL.0b013e31828c2f66. Epub 2013 Mar 20.
To explore the efficacy and stimulation frequency dependence of repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) in Parkinson disease (PD).
In this randomized, double-blind, sham-controlled, multicenter study with a parallel design, a weekly intervention was performed 8 times. The effects were monitored up to 20 weeks. By central registration, participants were assigned to 1 of 3 arms of the study: low-frequency (1-Hz) rTMS, high-frequency (10-Hz) rTMS, and realistic sham stimulation. The primary end point was the score change of the Unified Parkinson's Disease Rating Scale (UPDRS) part III from the baseline. Several nonmotor symptom scales such as the Hamilton Rating Scale for Depression, apathy score, and nonmotor symptoms questionnaire were defined as secondary end points.
Of the 106 patients enrolled, 36 were allocated to 1-Hz rTMS, 34 to 10-Hz rTMS, and 36 to realistic sham stimulation. Results show 6.84-point improvement of the UPDRS part III in the 1-Hz group at the last visit of the 20th week. Sham stimulation and 10-Hz rTMS improved motor symptoms transiently, but their effects disappeared in the observation period. Changes in nonmotor symptoms were not clear in any group. No severe adverse event was reported.
The 1-Hz rTMS over the SMA was effective for motor, but not nonmotor, symptoms in PD.
This study provides Class I evidence that 1-Hz rTMS over the SMA is effective for motor symptoms in PD.
探索经颅重复磁刺激（rTMS）对补充运动区（SMA）治疗帕金森病（PD）的疗效和刺激频率依赖性。
本研究采用随机、双盲、假刺激对照、多中心、平行设计，每周干预 8 次，共 20 周。通过中央登记，参与者被分配到研究的 3 个臂之一：低频（1Hz）rTMS、高频（10Hz）rTMS 和真实假刺激。主要终点是统一帕金森病评定量表（UPDRS）第三部分从基线的评分变化。定义了几个非运动症状量表，如汉密尔顿抑郁量表、淡漠评分和非运动症状问卷，作为次要终点。
在纳入的 106 例患者中，36 例分配至 1Hz rTMS 组、34 例分配至 10Hz rTMS 组、36 例分配至真实假刺激组。结果显示，在第 20 周的最后一次随访中，1Hz 组的 UPDRS 第三部分改善了 6.84 分。假刺激和 10Hz rTMS 可短暂改善运动症状，但在观察期内其效果消失。任何一组的非运动症状变化均不明显。未报告严重不良事件。
SMA 上的 1Hz rTMS 对 PD 的运动症状有效，但对非运动症状无效。
本研究提供了 I 级证据，表明 SMA 上的 1Hz rTMS 对 PD 的运动症状有效。
