Can Repetitive Transcranial Magnetic Stimulation Help On-Freezers with Parkinson’s Disease?

Background: Freezing of gait (FOG) or ―motor block‖ is experienced in about 30% of Parkinson’s disease (PD) patients within 5 years, and nearly in 60% after 10 years. Treatment of ―Off‖ time FOG is relatively straight forward, but ―On-freezing‖ is a difficult to treat scenario. Objective: This study evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in management of ―on-freezing‖ in patients with advanced PD. Methods: Sixteen Egyptian patients received 12 rTMS sessions over 4 weeks (either real or sham) using figure-of-8-shaped coil over the leg area of motor cortex contralaterally to the more affected side in addition to rehabilitation program involving specific gait training techniques. Primary efficacy variables were frequency of freezing episodes, FOG questionnaire (FOG Q) short form (SF), motor section and total score of unified PD rating scale (UPDRS), secondary outcomes were gait variables (Cadence, number of falls, stride length, stride time and turn time), and on-time. Patients were followed for 3 months. Results: There was improvement of FOG Q (SF), together with significant decrease in number of falls and widened stride length in patients receiving real rTMS. The total score of UPDRS and other gait variables were not significantly change. Dopaminergic drugs dosages were not reduced. No adverse effects were recorded apart from mild and transient headaches. Conclusion: rTMS may have a positive effect in on-freezers with advanced PD with subsequent decrease of number of falls. [Egypt J Neurol Psychiat Neurosurg. 2013; 50(4): 355-360]