Cerebellar rTMS for Essential Tremor
Cerebellar rTMS for Essential Tremor
Essential tremor (ET) is a low-mortality, though truly burdensome and debilitating condition
 which is known to be the second most common movement disorder of the adult population only
 after restless legs syndrome. The prevalence of the disorder in all age groups has been
 estimated to be 0.9%. Repetitive transcranial magnetic stimulation (rTMS) is an almost safe
 technique which has been used in diagnosis and treatment of many neurologic and psychiatric
 conditions. Recent studies have shown that cerebellum has a significant role in development
 of ET and that rTMS could exert therapeutic effects on its motor symptoms. In this study
 researchers will recruit at least 30 subjects among patients visiting at the Specialty Clinic
 of Mashhad Medical University according to researchers exclusion and inclusion criteria and
 after signing a written informed consent, will randomly be assigned to either real or sham
 rTMS. On the real rTMS arm, patients will be treated with 900 pulses of 1 Hz rTMS on 90% of
 resting motor threshold (RMT) delivered over each cerebellar hemisphere for 5 consecutive
 days and sham treatment will be performed with the same protocol using a small device placed
 on the TMS coil (not visible to the patients) producing electrical stimulation (less than 3
 mili amperes), to simulate the sensation of real TMS. Subject's ear will be protected with
 earplugs during both real and sham stimulations. After 2 months of follow-up, patients will
 undergo crossover and receive the other treatment as described above. Patients would be
 assessed using Fahn-Tolosa-Marin scale at the baseline and again on days 5, 12, and 30 after
 each real or sham treatment session by a blinded researcher. Data will be analysed by another
 researcher who is also blind.
Inclusion Criteria:

 -  having a diagnosis of essential tremor (ET) based on Movement Disorder Society
 criteria, involving at least one hand.

 -  18 years or above

 -  cognitively eligible to give informed consent of participation in the trial.

 Exclusion Criteria:

 -  Cardiac pace-maker or other implanted magnetic device or having other
 contraindications of performing a routine non-contrast MRI

 -  skin defect at the occipital area preventing placement of a coil

 -  Currently pregnant or plan for pregnancy in the next 6 months

 -  History of seizure

 -  Other comorbid medical conditions capable of producing or enhancing tremor

 -  advanced cardiac, renal, hepatic or other disabling conditions making patient physical
 unable to participate in examination and receiving the intervention

 -  Use of new drugs with potential effect on tremor