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Parkinson’s Disease
Volume 2013, Article ID 751925, 9 pages
Clinical Study

Repetitive Transcranial Magnetic Stimulation Improves Handwriting in Parkinson’s Disease

1Graduate Program in Rehabilitation Sciences, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3
2Department of Physiology, University of Arizona, McKale Center 229C, P.O. Box 210096, Tucson, AZ 85721, USA
3Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada V6T 1Z3

Received 15 February 2013; Accepted 25 March 2013

Academic Editor: Gammon M. Earhart

Copyright © 2013 Bubblepreet Kaur Randhawa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Parkinson disease (PD) is characterized by hypometric movements resulting from loss of dopaminergic neurons in the substantia nigra. PD leads to decreased activation of the supplementary motor area (SMA); the net result of these changes is a poverty of movement. The present study determined the impact of 5 Hz repetitive transcranial magnetic stimulation (rTMS) over the SMA on a fine motor movement, handwriting (writing cursive “l”s), and on cortical excitability, in individuals with PD. Methods. In a cross-over design, ten individuals with PD were randomized to receive either 5 Hz or control stimulation over the SMA. Immediately following brain stimulation right handed writing was assessed. Results. 5 Hz stimulation increased vertical size of handwriting and diminished axial pressure. In addition, 5 Hz rTMS significantly decreased the threshold for excitability in the primary motor cortex. Conclusions. These data suggest that in the short term 5 Hz rTMS benefits functional fine motor task performance, perhaps by altering cortical excitability across a network of brain regions. Further, these data may provide the foundation for a larger investigation of the effects of noninvasive brain stimulation over the SMA in individuals with PD.