Safety study of 50 Hz repetitive transcranial magnetic stimulation in patients with Parkinson’s disease
| Autor: | Mark Hallett, Eric M. Wassermann, Mikhail Lomarev, Nguyet Dang, Elise Houdayer, David H. Benninger, Grisel Lopez, Rebecca E. Fasano |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Male
medicine.medical_specialty Parkinson's disease medicine.medical_treatment Biophysics Electromyography Neurological disorder Neuropsychological Tests Audiology Electroencephalography Risk Assessment behavioral disciplines and activities Functional Laterality Article Physiology (medical) Reaction Time medicine Humans Verbal fluency test Muscle Skeletal Aged medicine.diagnostic_test Motor Cortex Parkinson Disease Middle Aged Evoked Potentials Motor medicine.disease Transcranial Magnetic Stimulation Electric Stimulation Sensory Systems Transcranial magnetic stimulation Treatment Outcome medicine.anatomical_structure Neurology Physical therapy Female Neurology (clinical) Primary motor cortex Mental Status Schedule Psychology Motor cortex |
| Zdroj: | Clinical Neurophysiology. 120:809-815 |
| ISSN: | 1388-2457 |
| Popis: | Objective Repetitive transcranial magnetic stimulation (rTMS) has shown promising results in treating Parkinson’s disease (PD), but the best values for rTMS parameters are not established. Fifty Hertz rTMS may be superior to ⩽ 25 Hz rTMS investigated so far. The objective of this study was to determine if 50 Hz rTMS could be delivered safely in PD patients since current safety limits are exceeded. Methods Fifty Hertz rTMS was applied with a circular coil on the primary motor cortex (M1). Stimulation intensity was first tested at 60% rest motor threshold [RMT] and 0.5 s train duration and then increased in 0.5 s steps to 2 s, and by 10% steps to 90% RMT. Multi-channel electromyography (EMG) was recorded to control for signs of increasing time-locked EMG activity including correlates of the spread of excitation and after-discharges, or an increase of M1 excitability. Pre- and post-50 Hz rTMS assessments included EEG, Unified Parkinson Disease Rating Scale (UPDRS), Grooved Pegboard Test, Serial Reaction Time Task (SRTT), Folstein Mini-Mental Status Examination (MMSE) and Verbal Fluency to control for motor and cognitive side effects. Results Ten PD patients were investigated. Multi-channel EMG showed no signs of increased time-locked EMG activity including correlates of the spread of excitation and after-discharges, or increased M1 excitability in 9 patients. A PD patient with bi-temporal spikes in the pre-testing EEG had clinical and EMG correlates of spread of excitation at 90% RMT, but no seizure activity. Pre- and post-50 Hz assessment showed no changes. No adverse events were observed. Fifty Hertz rTMS was well tolerated except by 1 patient who wished to terminate the study due to facial muscle stimulation. Conclusion Fifty Hertz rTMS at an intensity of 90% RMT for 2 s appears safe in patients with PD, but caution should be taken for patients with paroxysmal EEG activity. For this reason, comprehensive screening should include EEG before higher-frequency rTMS is applied. Significance This is the first study to investigate safety of 50 Hz rTMS in humans. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect