Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Department of Neurology, Medanta, Gurgaon, India.
Brain Connect. 2023 May;13(4):247-263. doi: 10.1089/brain.2022.0043. Epub 2023 Apr 4.
Parkinson's disease (PD) is a progressive disorder with alterations in cortical functional activity. Transcranial magnetic stimulation is known to incur motor benefits in PD by inducing motor activity through cortical connectivity, although the mechanisms are unclear. The effects of repetitive transcranial magnetic stimulation (rTMS) (at three cortical sites) on functional and structural plasticity were studied in PD to understand inhibitory or excitatory rTMS-induced motor improvement. The study was a single blind, randomized, sham-controlled type involving three groups. Three thousand rTMS pulses of frequency 1 Hz were given at primary motor area (in 13 patients of Group A) or premotor area (in Group B, = 18) and a frequency 5 Hz at supplementary motor area in Group C ( = 19). Clinical rating scores (Unified Parkinson's Disease Rating Scale [UPDRS], Parkinson's Disease Questionaire-39 [PDQ-39]) and motor dexterity were assessed at baseline, after sham and real rTMS sessions. Visuospatial functional magnetic resonance imaging task along with T1-weighted scans (at three Tesla) were used to evaluate the motor execution and planning post rTMS intervention. Improvements ( < 0.05) in UPDRS II, III, Mobility, and activities of daily living of PDQ-39, Purdue Pegboard were observed. Increased blood oxygen level-dependent (BOLD) activations (family-wise error [FWE]-corrected P-value [pFWE] <0.01) were observed in motor cortices, parietal association areas, and cerebellum in groups C and decrease in group A and B after real TMS as compared with sham. Repetitive TMS at motor (1 Hz) and supplementary motor (5 Hz) areas resulted in significant clinical benefits by inducing cortical plasticity. Impact statement TMS daily protocols have been commonly employed to modulate cortical connectivity in Parkinson's disease (PD). This study uses functional magnetic resonance imaging to assess rTMS-related effects in PD. Repetitive TMS protocol at higher pulses (3000/session) in primary and supplementary motor cortices administered weekly was clinically effective and safe. The results revealed functional restoration along with cortical plasticity mechanisms of externally generated movement in PD in response to noninvasive brain stimulation.
帕金森病（PD）是一种进行性疾病，其皮质功能活动发生改变。经颅磁刺激（TMS）通过皮质连接诱导运动活动，已知可在 PD 中引起运动益处，但其机制尚不清楚。本研究旨在探讨重复经颅磁刺激（rTMS）（在三个皮质部位）对 PD 中的功能和结构可塑性的影响，以了解抑制性或兴奋性 rTMS 诱导的运动改善。该研究是一项单盲、随机、假对照试验，涉及三个组。组 A 的 13 名患者接受了 1 Hz 频率的 3000 个 rTMS 脉冲，组 B 的 18 名患者接受了 1 Hz 频率的 rTMS 脉冲，组 C 的 19 名患者接受了 5 Hz 频率的 rTMS 脉冲。在基线、假刺激和真刺激 rTMS 后，使用统一帕金森病评定量表（UPDRS）和帕金森病问卷-39（PDQ-39）评估临床评分，使用运动灵巧性进行评估。使用视觉空间功能磁共振成像任务和 T1 加权扫描（3 Tesla）来评估 rTMS 干预后的运动执行和计划。观察到 PD 的 UPDRS II、III、运动和日常生活活动 PDQ-39、Purdue 钉板评分的改善（ < 0.05）。与假刺激相比，组 C 的运动皮质、顶叶联合区和小脑的血氧水平依赖（BOLD）激活增加（经校正的错误发现率 [FWE] P 值 [pFWE] <0.01），而组 A 和 B 的 BOLD 激活减少。与假刺激相比，运动（1 Hz）和辅助运动（5 Hz）区的 rTMS 可诱导皮质可塑性，从而显著改善临床获益。影响声明 TMS 日常方案通常用于调节帕金森病（PD）中的皮质连接。本研究使用功能磁共振成像来评估 PD 中的 rTMS 相关效应。在初级和辅助运动皮质中每周给予更高脉冲（3000/次）的 rTMS 方案在临床和安全方面均有效。结果表明，在 PD 中，对外源性运动进行非侵入性脑刺激后，通过外部产生的运动来恢复功能并产生皮质可塑性机制。
