Transcranial Magnetic Stimulation for Freezing of Gait in Parkinson's Disease

The First Affiliated Hospital with Nanjing Medical University85 enrolled

Overview

This study evaluated transcranial magnetic stimulation (TMS) for freezing of gait in patients with Parkinson's disease. Participants with Parkinson's disease and freezing of gait received conventional TMS protocols, and their clinical, gait, and neurophysiological outcomes were assessed. Patients who did not achieve sufficient improvement after conventional TMS were further treated with a combined primary motor cortex and cerebellar stimulation protocol. The study aimed to identify factors associated with differential response to conventional TMS and to explore whether cerebellar stimulation could improve symptoms in treatment-resistant patients.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Parkinson Disease (PD)

Interventions

Cerebellar Intermittent Theta-Burst StimulationDEVICE

Bilateral cerebellar intermittent theta-burst stimulation was delivered using 50-Hz triplets at 5 Hz, with 2-second trains every 10 seconds and a total of 2700 pulses over 15 minutes. This intervention was administered to patients who were treatment-resistant to conventional TMS.

Eligibility

Sex: ALLMin age: 40 Years

Medical Language ↔ Plain English

Inclusion Criteria: * (1) a score of ≥ 1 on MDS-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Item 13 or FOGQ Item 3, with freezing episodes during gait initiation, turning, or navigating narrow spaces confirmed by two independent investigators; (2) a stable antiparkinsonian medication regimen for at least four weeks before enrollment; (3) right-handedness; (4) age ≥ 40 years; (5) no current use of antidepressants, anxiolytics, or antipsychotic agents. Antiparkinsonian medications and their dosages remained unchanged throughout the study. Exclusion Criteria: * (1) personal or family history of atypical parkinsonian syndromes, including multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Wilson's disease, and vascular parkinsonism; (2) coexisting movement disorders or other neurodegenerative conditions; (3) gait-impairing disorders such as primary progressive freezing of gait; (4) impaired consciousness, or visual, auditory, or language deficits that precluded full assessment; (5) severe systemic diseases, including cardiopulmonary disorders, hepatic or renal insufficiency, malignancies, and hematologic or autoimmune diseases; (6) prior cranial surgery or deep brain stimulation (DBS); (7) pregnancy; (8) history of epilepsy; (9) severe cognitive impairment with a Mini-Mental State Examination (MMSE) score below 24; and (10) other contraindications to TMS.

Outcomes

Primary Outcomes

Freezing of Gait Questionnaire Improvement Rate

The improvement rate of the Freezing of Gait Questionnaire was calculated as \[(pre-treatment FOGQ score at baseline - post-treatment FOGQ score at one-month follow-up) / pre-treatment FOGQ score at baseline\] × 100%. Participants with an improvement rate of at least 30% were classified as treatment responsive.

Time frame: Baseline and 1 month after treatment

Secondary Outcomes

Unified Parkinson's Disease Rating Scale Part III Score

Motor symptoms were assessed using the Unified Parkinson's Disease Rating Scale Part III.

Time frame: Baseline, within 24 hours after treatment, and 1 month after treatment

Upper-Limb Short-Interval Intracortical Inhibition

Upper-limb short-interval intracortical inhibition was assessed using paired-pulse transcranial magnetic stimulation and expressed as the conditioned/unconditioned motor evoked potential amplitude ratio.

Time frame: Baseline and within 24 hours after treatment