Clinical efficacy of Repetitive Deep TMS in Patient with Parkinson’s disease: a pilot study

Pharmaceutical therapy can provide effective symptomatic relief for Parkinson’s disease (PD) initially, but symptoms become more complex and refractory as the disease progresses, necessitating alternative therapeutic approaches. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive technique for brain stimulation, which is recommended as a potential therapeutic tool for various neurological and psychiatric disorders. This study aimed to investigate the effects of deep rTMS using an H-coil on cerebral perfusion and motor function in PD. Five PD patients underwent high-frequency dTMS over the supplementary motor area (SMA) for two weeks. Clinical assessments, including the Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn-Yahr scale, and Timed-Up-Go (TUG) test, were conducted before and three months after dTMS. Brain perfusion was evaluated using single-photon emission computed tomography (SPECT) and analyzed with statistical parametric mapping. There were no statistically significant changes in Hoehn-Yahr scale, TUG, or UPDRS motor scores following dTMS intervention. However, SPECT analysis revealed a significant increase in regional cerebral blood flow (rCBF) in the right cerebellum after dTMS treatment. Although dTMS did not result in significant clinical improvements in motor symptoms, it was associated with increased cerebellar perfusion, suggesting potential neuromodulatory effects. Therefore, we cautiously suggest that rTMS procedure may be a new therapeutic option for PD. Further studies are necessary to investigate associations between changes in rCBF and motor function tests after rTMS application in PD.