Transcranial Magnetic Stimulation for the Treatment of Parkinson's Disease
Transcranial Magnetic Stimulation for the Treatment of Parkinson's Disease
The problems in motor activity associated with Parkinson's disease are still poorly
 understood. Patients with Parkinson's disease often suffer from extremely slow movements
 (bradykinesia) which result in the inability to perform complex physical acts.

 Imaging studies of the brain have provided researchers with information about the specific
 areas in the brain associated with these motor difficulties. One particular area involved is
 the surface of the brain called the cerebral cortex.

 Transcranial Magnetic Stimulation (TMS) is a non-invasive technique that can be used to
 stimulate brain activity and gather information about brain function. It is very useful when
 studying the areas of the brain related to motor activity (motor cortex, corticospinal tract,
 and corpus callosum). Repetitive transcranial magnetic stimulation (rTMS) involves the
 placement of a cooled electromagnet with a figure-eight coil on the patient's scalp and
 rapidly turning on and off the magnetic flux. This permits non-invasive, relatively localized
 stimulation of the surface of the brain (cerebral cortex). The effect of magnetic stimulation
 varies, depending upon the location, intensity and frequency of the magnetic pulses.

 Researchers plan to study the therapeutic effects of repetitive transcranial magnetic
 stimulation (rTMS) on complex motor behavior of patients with Parkinson's disease. In order
 to measure its effectiveness, patients will be asked to perform complex tasks, such as
 playing the piano while receiving transcranial magnetic stimulation.
The physiology of the motor disturbance in Parkinson's disease is not completely understood.
 One of the major and perhaps most disabling manifestations of PD is bradykinesia. It is
 particularly difficult for these patients to perform simultaneous, sequential and complex
 motor acts. Imaging studies have recently provided important information in reference to the
 brain regions associated with performance of these motor sequences in normal volunteers and
 in PD patients. These studies helped us to identify the brain regions active in association
 with task performance. It has been suggested that cortical regions, and particularly the SMA
 are less active in patients with PD than in controls in association with motor performance.

 We plan to study the effects of subthreshold rTMS delivered to SMA and primary motor cortex
 in patients with PD "on" and "off" medication. From this study, we expect to learn if
 stimulation of the scalp overlying primary motor cortex and SMA can ameliorate performance of
 simple and complex motor sequences in PD.

 Subthreshold rTMS has been proposed as a therapeutic tool in psychiatric disorders. In the
 motor domain, subthreshold rTMS delivered to primary motor cortex improves reaction times and
 motor performance in patients with Parkinson's disease. The mechanisms underlying this
 beneficial effect are not known. However, they may be related with subthreshold rTMS
 replacing the missing excitatory drive on the motor cortex.
Patients with PD.

 No epilepsy.

 No seizures.

 No metal in the head.