Review Article

Therapeutic Application of rTMS in Atypical Parkinsonian Disorders

Table 1

Studies assessing the effects of rTMS in PSP.

Author, yearType of studyStudy designResults

Brusa et al. [34]Prospective cohort study/open label(i) 10 PSP patients, 10 PD patients, 10 HC
(ii) Lateral cerebellum bilaterally
(iii) ITBS protocol (3 50 Hz pulses, repeated at a rate of 5 Hz, 20 trains of 10 bursts in 8 s intervals, 600 pulses, 80% of AMT intensity) for two weeks
(iv) Assessment at baseline and after 2 weeks via rs-fMRI and PSP-RSc
(i) Clinical improvement (dysarthria, gait) and a parallel enhancement in functional connectivity between the cerebellar hemisphere and motor cortex
(ii) No adverse events
Dale et al. [35]2 PSP study cases/sham controlled(i) 2 PSP patients
(ii) Cerebellum
(iii) RTMS (10 Hz, 4.000 pulses, 4 seconds on, 8 seconds off, 100 trains, 90-110% of RMT intensity) 10 days active 10 days sham stimulation, separated by a month
(iv) Assessment at baseline and immediately after treatment
(i) CBI increased/improvement in stability and speech
(ii) Pending tolerability
Pilotto et al. [36]Double blind/sham controlled(i) 20 PSP patients
(ii) Cerebellum
(iii) TBS (3 50 Hz pulses repeated at a rate of 5 Hz, 20 trains of 10 bursts in 8 s intervals, 600 pulses, 80% RMT intensity)
(iv) Clinical evaluation (Tinetti test, the Short Physical Performance Battery (SPPB), the Timed Up and Go test, and the Functional Reach test (FR)) and static balance assessed before and after active and sham stimulation, inertial sensor unit (IMU) processing accelerator signals
(i) Beneficial effect on postural instability and improvement in area, velocity, acceleration, and jerkiness of sway
(ii) No adverse events
Santens et al. [37]Prospective cohort study/open label(i) 6 PSP patients
(ii) Lower limb motor area
(iii) RTMS (10 Hz, 1.000 pulses, 5 seconds on, 55 seconds off, 20 trains, 80% of MT intensity) for 5 consecutive days
(iv) Assessment with PSP-RSc at baseline and after 5 days
(i) Improvement on the gait and midline symptoms
(ii) No adverse events/discomfort during the stimulation
Nishida et al. [38]Prospective cohort study/open label(i) 7 PSP patients
(ii) Supplementary motor area (SMA)
(iii) RTMS (5 Hz, 500 pulses,10 trains, 10 seconds on, 110% of RMT intensity) for 10 days
(iv) Assessment using PSP-RSc at baseline and immediately after treatment
(i) Improvement of the PSP-RS by 7 points
(ii) No adverse events
Major et al. [39]1 PSP case study/open label(i) 1 PSP patient
(ii) Bilateral motor cortex area
(iii) LF-rTMS (1 Hz, 80% of RMT intensity) 20 min per day, for five consecutive days
(iv) Assessment using mechanometry and goniometry at baseline and after 5 days
(i) Increase in the range of motions and in the muscle forces
(ii) No adverse events
Boulogne et al. [40]1 PSP case study/open label(i) 1 PSP patient
(ii) Right dorsolateral prefrontal cortex (DLPFC)
(iii) LF-rTMS (1 Hz, 6 trains, 1 min on–30 sec off, 120% of RMT intensity)
(iv) Assessment at baseline and immediately after treatment via the Montgomery Asberg Depression Rating scale (MADRS), the State-Trait Anxiety Inventory (STAI), the Lille Apathy Rating Scale (LARS), and the Global Assessment of Functioning (GAF) Scale. The PSP-RSc and the MoCA were assessed before and after the rTMS treatment
(i) Relieve depression/MADS and STAI scores decreased; the LARS and GAF scale scores increased after rTMS
(ii) No adverse events
Madden et al. [41]1 PSP study cases/sham controlled(i) 1 PSP patient
(ii) Left dorsolateral prefrontal cortex (DLPFC)
(iii) TDCS
(iv) Assessment at baseline and immediately after treatment via language tasks
(i) Improve phonemic fluency and action naming
(ii) No adverse events