Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease
Identifieur interne : 000C39 ( PascalFrancis/Checkpoint ); précédent : 000C38; suivant : 000C40Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease
Auteurs : Jean-Pascal Lefaucheur [France] ; Xavier Drouot [France] ; Florian Von Raison [France] ; Isabelle Menard-Lefaucheur [France] ; Pierre Cesaro [France] ; Jean-Paul Nguyen [France]Source :
- Clinical neurophysiology [ 1388-2457 ] ; 2004.
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Abstract
Objective: To assess the effects of focal motor cortex stimulation on motor performance and cortical excitability in patients with Parkinson's disease (PD). Methods: Repetitive transcranial magnetic stimulation (rTMS) was performed on the left motor cortical area corresponding to the right hand in 12 'off-drug' patients with PD. The effects of subthreshold rTMS applied at 0.5 Hz (600 pulses) or at 10 Hz (2000 pulses) using a 'real' or a 'sham' coil were compared to those obtained by a single dose of 1-dopa. The assessment included a clinical evaluation by the Unified Parkinson's Disease Rating Scale and timed motor tasks, and a neurophysiological evaluation of cortical excitability by single- and paired-pulse TMS techniques. Results: 'Real' rTMS at 10 or 0.5 Hz, but not 'sham' stimulation, improved motor performance. High-frequency rTMS decreased rigidity and bradykinesia in the upper limb contralateral to the stimulation, while low-frequency rTMS reduced upper limb rigidity bilaterally and improved walking. Concomitantly, 10 Hz rTMS increased intracortical facilitation, while 0.5 Hz rTMS restored intracortical inhibition. Conclusions: Low- and high-frequency rTMS of the primary motor cortex lead to significant but differential changes in patients with PD both on clinical and electrophysiological grounds. The effects on cortical excitability were opposite to previous observations made in healthy subjects, suggesting a reversed balance of cortical excitability in patients with PD compared to normals. However, the underlying mechanisms of these changes remain to determine, as well as the relationship with clinical presentation and response to 1-dopa therapy. Significance: The present study gives some clues to appraise the role of the primary motor cortex in PD. Clinical improvement induced by rTMS was too short-lasting to consider therapeutic application, but these results support the perspective of the primary motor cortex as a possible target for neuromodulation in PD.
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<front><div type="abstract" xml:lang="en">Objective: To assess the effects of focal motor cortex stimulation on motor performance and cortical excitability in patients with Parkinson's disease (PD). Methods: Repetitive transcranial magnetic stimulation (rTMS) was performed on the left motor cortical area corresponding to the right hand in 12 'off-drug' patients with PD. The effects of subthreshold rTMS applied at 0.5 Hz (600 pulses) or at 10 Hz (2000 pulses) using a 'real' or a 'sham' coil were compared to those obtained by a single dose of 1-dopa. The assessment included a clinical evaluation by the Unified Parkinson's Disease Rating Scale and timed motor tasks, and a neurophysiological evaluation of cortical excitability by single- and paired-pulse TMS techniques. Results: 'Real' rTMS at 10 or 0.5 Hz, but not 'sham' stimulation, improved motor performance. High-frequency rTMS decreased rigidity and bradykinesia in the upper limb contralateral to the stimulation, while low-frequency rTMS reduced upper limb rigidity bilaterally and improved walking. Concomitantly, 10 Hz rTMS increased intracortical facilitation, while 0.5 Hz rTMS restored intracortical inhibition. Conclusions: Low- and high-frequency rTMS of the primary motor cortex lead to significant but differential changes in patients with PD both on clinical and electrophysiological grounds. The effects on cortical excitability were opposite to previous observations made in healthy subjects, suggesting a reversed balance of cortical excitability in patients with PD compared to normals. However, the underlying mechanisms of these changes remain to determine, as well as the relationship with clinical presentation and response to 1-dopa therapy. Significance: The present study gives some clues to appraise the role of the primary motor cortex in PD. Clinical improvement induced by rTMS was too short-lasting to consider therapeutic application, but these results support the perspective of the primary motor cortex as a possible target for neuromodulation in PD.</div>
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</fC03>
<fC03 i1="05" i2="X" l="ENG"><s0>Parkinson disease</s0>
<s5>09</s5>
</fC03>
<fC03 i1="05" i2="X" l="SPA"><s0>Parkinson enfermedad</s0>
<s5>09</s5>
</fC03>
<fC03 i1="06" i2="X" l="FRE"><s0>Homme</s0>
<s5>54</s5>
</fC03>
<fC03 i1="06" i2="X" l="ENG"><s0>Human</s0>
<s5>54</s5>
</fC03>
<fC03 i1="06" i2="X" l="SPA"><s0>Hombre</s0>
<s5>54</s5>
</fC03>
<fC03 i1="07" i2="X" l="FRE"><s0>Electrodiagnostic</s0>
<s5>57</s5>
</fC03>
<fC03 i1="07" i2="X" l="ENG"><s0>Electrodiagnosis</s0>
<s5>57</s5>
</fC03>
<fC03 i1="07" i2="X" l="SPA"><s0>Electrodiagnóstico</s0>
<s5>57</s5>
</fC03>
<fC03 i1="08" i2="X" l="FRE"><s0>Neuromodulation</s0>
<s5>58</s5>
</fC03>
<fC03 i1="08" i2="X" l="ENG"><s0>Neuromodulation</s0>
<s5>58</s5>
</fC03>
<fC03 i1="08" i2="X" l="SPA"><s0>Neuromodulación</s0>
<s5>58</s5>
</fC03>
<fC03 i1="09" i2="X" l="FRE"><s0>Stimulation magnétique transcrânienne</s0>
<s4>CD</s4>
<s5>96</s5>
</fC03>
<fC03 i1="09" i2="X" l="ENG"><s0>Transcranial magnetic stimulation</s0>
<s4>CD</s4>
<s5>96</s5>
</fC03>
<fC03 i1="10" i2="X" l="FRE"><s0>Période muette</s0>
<s4>CD</s4>
<s5>97</s5>
</fC03>
<fC03 i1="10" i2="X" l="ENG"><s0>Silent period</s0>
<s4>CD</s4>
<s5>97</s5>
</fC03>
<fC03 i1="11" i2="X" l="FRE"><s0>Bradykinésie</s0>
<s4>CD</s4>
<s5>98</s5>
</fC03>
<fC03 i1="11" i2="X" l="ENG"><s0>Bradykinesia</s0>
<s4>CD</s4>
<s5>98</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Encéphale pathologie</s0>
<s5>20</s5>
</fC07>
<fC07 i1="01" i2="X" l="ENG"><s0>Cerebral disorder</s0>
<s5>20</s5>
</fC07>
<fC07 i1="01" i2="X" l="SPA"><s0>Encéfalo patología</s0>
<s5>20</s5>
</fC07>
<fC07 i1="02" i2="X" l="FRE"><s0>Voie motrice</s0>
<s5>22</s5>
</fC07>
<fC07 i1="02" i2="X" l="ENG"><s0>Motor pathway</s0>
<s5>22</s5>
</fC07>
<fC07 i1="02" i2="X" l="SPA"><s0>Vía motora</s0>
<s5>22</s5>
</fC07>
<fC07 i1="03" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0>
<s5>23</s5>
</fC07>
<fC07 i1="03" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0>
<s5>23</s5>
</fC07>
<fC07 i1="03" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0>
<s5>23</s5>
</fC07>
<fC07 i1="04" i2="X" l="FRE"><s0>Maladie dégénérative</s0>
<s5>24</s5>
</fC07>
<fC07 i1="04" i2="X" l="ENG"><s0>Degenerative disease</s0>
<s5>24</s5>
</fC07>
<fC07 i1="04" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0>
<s5>24</s5>
</fC07>
<fC07 i1="05" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0>
<s5>25</s5>
</fC07>
<fC07 i1="05" i2="X" l="ENG"><s0>Central nervous system disease</s0>
<s5>25</s5>
</fC07>
<fC07 i1="05" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0>
<s5>25</s5>
</fC07>
<fC07 i1="06" i2="X" l="FRE"><s0>Système nerveux pathologie</s0>
<s5>26</s5>
</fC07>
<fC07 i1="06" i2="X" l="ENG"><s0>Nervous system diseases</s0>
<s5>26</s5>
</fC07>
<fC07 i1="06" i2="X" l="SPA"><s0>Sistema nervioso patología</s0>
<s5>26</s5>
</fC07>
<fN21><s1>262</s1>
</fN21>
</pA>
</standard>
</inist>
<affiliations><list><country><li>France</li>
</country>
<region><li>Île-de-France</li>
</region>
<settlement><li>Créteil</li>
</settlement>
</list>
<tree><country name="France"><region name="Île-de-France"><name sortKey="Lefaucheur, Jean Pascal" sort="Lefaucheur, Jean Pascal" uniqKey="Lefaucheur J" first="Jean-Pascal" last="Lefaucheur">Jean-Pascal Lefaucheur</name>
</region>
<name sortKey="Cesaro, Pierre" sort="Cesaro, Pierre" uniqKey="Cesaro P" first="Pierre" last="Cesaro">Pierre Cesaro</name>
<name sortKey="Drouot, Xavier" sort="Drouot, Xavier" uniqKey="Drouot X" first="Xavier" last="Drouot">Xavier Drouot</name>
<name sortKey="Drouot, Xavier" sort="Drouot, Xavier" uniqKey="Drouot X" first="Xavier" last="Drouot">Xavier Drouot</name>
<name sortKey="Lefaucheur, Jean Pascal" sort="Lefaucheur, Jean Pascal" uniqKey="Lefaucheur J" first="Jean-Pascal" last="Lefaucheur">Jean-Pascal Lefaucheur</name>
<name sortKey="Menard Lefaucheur, Isabelle" sort="Menard Lefaucheur, Isabelle" uniqKey="Menard Lefaucheur I" first="Isabelle" last="Menard-Lefaucheur">Isabelle Menard-Lefaucheur</name>
<name sortKey="Nguyen, Jean Paul" sort="Nguyen, Jean Paul" uniqKey="Nguyen J" first="Jean-Paul" last="Nguyen">Jean-Paul Nguyen</name>
<name sortKey="Von Raison, Florian" sort="Von Raison, Florian" uniqKey="Von Raison F" first="Florian" last="Von Raison">Florian Von Raison</name>
</country>
</tree>
</affiliations>
</record>
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