rTMS for On-Freezers with Advanced PD. A Long Term Follow Up Study (S40.001)

Shehata, H., N. Shalaby, M. El-Tamawy, and S. Jaafary, "rTMS for On-Freezers with Advanced PD. A Long Term Follow Up Study (S40.001)", Neurology, vol. 86, issue 16 Supplement, April 5, 2016.


Objective: Evaluating the long term efficacy and safety of rTMS sessions in management of ‘on-freezing’ and unpredicted offs in advanced Parkinson’s disease (PD).Background:Freezing of gait (FOG) is an independent feature of Parkinson’s disease that is related to both motor and cognitive deficits. Treatment of off-FOG is relatively straightforward, but ‘on-freezing’ is a difficult-to-treat scenario and it needs a multidisciplinary team approach.Design/Methods:A randomized, double-blind, placebo-controlled study included 43 patients with advanced PD who received 12 sessions of rTMS over 4 weeks (real or sham) every 3 months for a period of 9 months. rTMS (20 trains of 50 stimuli each, at 5 Hz) was delivered over the leg motor area contralaterally to the more affected side followed by a specific rehabilitation program (60 minutes). Treatments were synchronized with “on-time” to facilitate training sessions. All patients had their daily diary to record ‘on-times’, ‘offs’, ‘falls’, and ‘freezing episodes’. Primary efficacy variables were FOG Q (SF), unpredicted offs and UPDRS (motor section), secondary outcomes were on-time and gait variables (cadence, falls number, stride length and turn time). All patients signed a written consent.Results: Freezing episodes significantly decreased (p<0.05) and FOG Q (SF) significantly improved (p<0.001) in the active arm. Attacks of unpredicted offs also decreased significantly (p 0.03), whereas, the motor section of UPDRS improved, yet this was statistically non-significant. Number of falls reduced significantly (p<0.001) with improvement of turn time (p 0.04). Other gait variables were not affected. Long-term effects: the effects were maintained over the study period, the doses of dopaminergic drugs were individualized and modified according to the disease progression in both groups. No adverse events were recorded apart from mild transient headaches.Conclusions:rTMS has a positive effect in on-freezers with advanced PD with subsequent decrease of number of falls.Disclosure: Dr. Shehata has nothing to disclose. Dr. Shalaby has nothing to disclose. Dr. El-Tamawy has nothing to disclose. Dr. Jaafary has nothing to disclose.



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