Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea; Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA.
Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA.
Parkinsonism Relat Disord. 2019 Jul;64:304-307. doi: 10.1016/j.parkreldis.2019.03.019. Epub 2019 Mar 24.
The possibility of repetitive transcranial magnetic stimulation (rTMS) as an alternative therapy for essential tremor (ET) patients has emerged. However, its effect on medicated ET patients is lacking. The aim of this pilot study was to investigate the effect of cerebellar low-frequency rTMS as an "add-on" treatment.
In this single-blinded, randomized, sham-controlled pilot study, patients with ET were randomized into two groups, one receiving real-rTMS and the other sham-rTMS. For 5 days, 1200 stimulations per day were applied to the bilateral cerebellar hemispheres at an intensity of 90% of the resting motor threshold (RMT) with a frequency of 1-Hz. Motor evoked potentials (MEPs) and the Fahn-Tolosa-Marin tremor rating scales (TRS) were measured before, immediately, and 4 weeks after the completion of the rTMS procedures. All patients continued taking medications during all procedures.
Among 22 patients, 12 and 10 patients were randomized into the real- and sham-rTMS groups, respectively. Repeated analysis of variance (ANOVA) measurements showed that the total TRS, TRS-A and B were changed both in real and sham-rTMS groups without interaction between time and group. TRS-C and MEPs, were not significantly changed at each follow-up point in either the real or sham-rTMS sessions.
We conclude that cerebellar low-frequency rTMS is safe, but has no significant effect as an "add-on" therapy in patients with ET.
重复经颅磁刺激（rTMS）作为特发性震颤（ET）患者的替代治疗方法的可能性已经出现。然而，它对服用药物的 ET 患者的影响尚不清楚。本研究旨在探讨小脑低频 rTMS 作为“附加”治疗的效果。
这是一项单盲、随机、假刺激对照的初步研究，将 ET 患者随机分为两组，一组接受真 rTMS 治疗，另一组接受假 rTMS 治疗。在 5 天内，每天在双侧小脑半球以 90%的静息运动阈值（RMT）强度应用 1Hz 的频率施加 1200 次刺激。在 rTMS 程序完成之前、之后立即和 4 周后测量运动诱发电位（MEPs）和 Fahn-Tolosa-Marin 震颤评定量表（TRS）。所有患者在所有过程中继续服用药物。
在 22 名患者中，12 名和 10 名患者分别随机分为真 rTMS 和假 rTMS 组。重复方差分析（ANOVA）测量表明，总 TRS、TRS-A 和 B 在真和假 rTMS 组均发生变化，时间和组之间没有相互作用。在真或假 rTMS 治疗中，每个随访点的 TRS-C 和 MEPs 均无明显变化。
我们得出结论，小脑低频 rTMS 是安全的，但作为 ET 患者的“附加”治疗方法没有显著效果。
