Can Transcranial Magnetic Stimulation Improve Axial Symptoms in Parkinson’s Disease? (P5.378)

OBJECTIVE: To explore and compare the effects of repetitive transcranial magnetic stimulation (rTMS) interventions over two different pre-motor cortex areas on refractory axial symptoms (AxS) of Parkinson’s disease (PD). BACKGROUND: AxS such as balance, posture, and gait dysfunction are predictors of decreased quality of life and survival in PD. They tend to progress and become refractory to treatment. Transcranial magnetic brain stimulation (TMS) is emerging as a safe tool to study and treat different neuro-psychiatric disorders. Cortical pre-motor areas are known to be involved in movement coordination, axial muscle preparation for movement, and processing of complex multi-segmental movements. TMS neuromodulation over pre-motor areas might have therapeutic potential for PD-related AxS. DESIGN/METHODS: Fifteen PD patients with H&Y scores 2-3 participated in a parallel double-blind randomized pilot study of four weekly sessions of low-frequency rTMS and were assessed 4 weeks post-treatment completion. Stimulation arms were rTMS over dorsal pre-motor cortex and supplementary motor area (PMd+SMA) or sham over PMd and rTMS over SMA (SMA-alone). UPDRS-III and subsets of axial, tremor, rigidity, and bradykinesia items were the outcomes. Wilcoxon signed-rank and Mann-Whitney tests were used for analysis. RESULTS: Both PMd+SMA and SMA-alone decreased UPDRS-III (z=-2.21, p=0.027; z=-2.21, p=0.027). Subset analyses showed SMA-alone decreased bradykinesia subset (z=-2.21, p=0.027) and PMd+SMA decreased bradykinesia and axial subsets (z=-1.82, p=0.058; z=-2.00, p=0.045). Comparison between interventions showed that PMd+SMA decreased axial subset score by 22.6[percnt] while SMA-alone increased by 1.3[percnt] (U=4.0, p=0.026). No other subset showed significant differences. Clinical and demographic information did not differ between groups. CONCLUSIONS: Both rTMS interventions were well-tolerated and improved bradykinesia and UPDRS-III total motor scores. The AxS score improvements seen only in the PMd+SMA group suggest that low-frequency rTMS over PMd and SMA together, could be a promising therapy for AxS. Larger placebo-controlled studies need to be conducted to corroborate its efficacy. Disclosure: Dr. Biagioni has nothing to disclose. Dr. Son has nothing to disclose. Dr. Cucca has nothing to disclose. Dr. Sticklor has nothing to disclose. Dr. Agarwal has nothing to disclose. Dr. Dacpano has nothing to disclose. Dr. Brys has nothing to disclose. Dr. Battenberg has nothing to disclose. Dr. Singleton-Garvin has nothing to disclose. Dr. Kumar has nothing to disclose. Dr. Gilbert has nothing to disclose. Dr. Quartarone has nothing to disclose. Dr. Di Rocco has nothing to disclose.