Neurorehabil Neural Repair 27: 79–86. [Prepared by Marco YC Pang, CAP Editor.] Question: Does adding repetitive transcranial magnetic
stimulation (rTMS) to treadmill training modulate cortical excitability and improve walking in people with Parkinson’s disease (PD)? Design: Randomised controlled trial with blinded outcome assessment. Setting: A medical centre in Taiwan. Participants: Individuals with Parkinson’s disease (Hoehn and Yahr Stage 2–3), and ability to walk independently were key inclusion criteria. Absence of selleck products motor evoked potential in response to rTMS, history of seizure, and use of cardiac pacemaker were key exclusion criteria. Randomisation of 22 participants allocated 11 to each of the experimental and control groups. Interventions: Both groups underwent 12 treatment sessions over 4 weeks. In each session, the experimental group received rTMS (5 Hz) applied over the leg area of the motor cortex in the hemisphere contralateral to the more affected leg for 6 minutes, immediately followed by 30 minutes of treadmill training. The control group received sham rTMS in addition to the 12 sessions of treadmill training. Outcome measures: The primary outcomes were indicators of corticomotor excitability – motor threshold, silent period, short-latency and long-latency intracortical inhibition – measured
in both cerebral hemispheres. The secondary outcomes were comfortable and fast walking speeds, and the timed-up-andgo test. The outcomes were measured at baseline and after the 4-week intervention period. Results: 20 participants completed the study. At the end of the 4-week MS-275 intervention
period, the increase in motor threshold of 3.5% and silent period of 14.0% of the contralateral hemisphere relative to the more affected leg was significantly more in the experimental group than the control group. Significantly more reduction of no short-latency intracortical inhibition in the same hemisphere was also found in the experimental group relative to the control group 10.9%. The experimental group also had significantly more improvement than the control group in fast walking speed (by 10.1 cm/s) and in the timedup- and-go test (by 2.0 s). No significant differences between the groups were reported in other outcomes. Conclusion: Repetitive transcranial magnetic stimulation can enhance the effects on corticomotor inhibition and improvement of walking function induced by treadmill training in patients with Parkinson’s disease. The application of non-invasive brain stimulation in rehabilitation has received considerable attention recently. Repetitive transcranial magnetic stimulation (rTMS) has been shown to enhance upper and lower extremity functions and/or modulate cortical excitability (Gonzalez-Garcia 2011, Khedr et al 2003, Lefaucheur et al 2004, Lomarev et al 2006).