Cerebellar Theta-Burst Stimulation for the Evaluation of the Pathophysiology and the Therapeutic Potential for Rest Tremor in Parkinson’s Disease
Objective: To investigate whether functional activation or inhibition of the cerebellum by transcranial magnetic stimulation modulates rest tremor in Parkinson's disease.
Background: Rest tremor in Parkinson's disease (PD) is disabling and responds often incompletely to conventional therapy. The pathogenesis remains largely unknown and therapeutic alternatives are needed. Functional imaging, neurophysiology and structural studies, and stereotactic surgery point to an involvement of the cerebellum and the cerebello-thalamo-cortical pathway in generation of Parkinsonian tremor, but the precise nature of the functional disturbance remains unknown.
Methods: In a randomized, double-blind, sham-controlled, cross-over study design, 15 PD patients with rest tremor underwent single sessions of continuous TBS (cTBS, inhibitory), intermittent (iTBS, excitatory) and sham stimulation of both cerebellar hemispheres. Assessment of rest tremor, motor function and neurophysiology were performed before and after each intervention including a 14-day monitoring of tremor and motor activity.
Results: Continuous TBS, intermittent TBS and sham stimulation of the cerebellum had no effects on tremor and motor performance and failed to restore cerebello-cortical inhibition in Parkinson's disease.
Conclusions: The contribution of cerebellar dysfunction in the pathophysiology of Parkinson's disease remains undetermined, but cerebellar stimulation may not offer a therapeutic alternative for tremor.
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D. Benninger, J. McNames. Hermann, F. Medlin, F. Vingerhoets, and M. Stephan. Cerebellar theta-burst stimulation for the evaluation of the pathophysiology and the therapeutic potential for rest tremor in Parkinson’s disease. Movement, 30(S1):S31, Jun 2015.