P029 Effects of dual-mode non-invasive brain stimulation on freezing of gait in patients with Parkinson’s disease ☆

Purpose Our previous study demonstrated the favorable effect of repetitive transcranial magnetic stimulation (rTMS) over both the dominant primary motor cortex of lower leg (M1-LL) and the left dorsolateral prefrontal cortex (DLPFC). The aim of this study was to investigate the effects of dual-mode non-invasive brain stimulation (NBS) on FOG using both rTMS and tDCS in patients with PD. Methods This study was a randomized controlled double-blind study comparing the effect of single vs. dual-mode stimulation. Thirty-two patients with PD that featured FOG were included and divided into two groups. For the dual-mode stimulation, 10Hz rTMS over the dominant M1-LL and the anodal tDCS over the left DLPFC were simultaneously applied for 20min per session, 5 sessions in a week. For the single stimulation, rTMS were applied at the same manner. Behavioral, neurophysiologic and cognitive outcomes were measured before, after, and 1week after the intervention by the Timed Up and Go (TUG) test, Standing Start 180° Turn (SS-180° Turn Step/Time) test, Unified Parkinson's Disease Rating Scale (UPDRS) part III, FOG Questionnaire (FOG-Q), motor evoked potential, Korean version of Montreal Cognitive Assessment (K-MOCA), Digit span-Forward/Back and Trail Making-A/B. Results There were significant improvements in TUG, SS-180° Turn Step, UPDRS part III and FOG-Q in both the dual-mode and the single stimulation group ( p 0.05). The dual-mode stimulation also resulted in significant improvements in SS-180° Turn Time ( p =0.008), K-MOCA ( p =0.004), Digit span-Forward ( p =0.015) and Trail making-B test ( p =0.010), whereas single stimulation did not. Furthermore, improvement of Trail making-B test was significantly greater after the dual-mode stimulation than the single stimulation ( p =0.024). Conclusion The dual-mode stimulation using the 10Hz rTMS over the dominant M1-LL and the anodal tDCS over the left DLPFC was more effective than single stimulation for improving FOG in combination with cognitive improvement in patients with PD.