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1 Hz cerebellum rTMS can modify the voluntary movements of the upper limb in early Parkinson's disease patients Eduard Minks1, Tomáš Pavlík2, Radek Mareček1, Petra Ovesná2, Martin Bareš1 1) First Department of Neurology, St. Anne's University Hospital and School of Medicine, Masaryk University, Brno, Czech Republic 2) Institute of Biostatistics and Analyses at the School of Medicine and the School of Science, Masaryk University, Brno, Czech Republic Objective: The cerebellum is strongly involved in motor system. Repetitive transcranial magnetic stimulation (rTMS) of the cerebellum can influence motor cortex and movement [1,2,3]. The aim of this study was to find whether 1 Hz cerebellar repetitive transcranial magnetic stimulation (rTMS) could affect upper limb movement in early-stage Parkinson’s disease (PD). Materials and methods: There were 20 patients in early stage of PD in this study. Every patient underwent one rTMS session with real stimulation and one session with sham stimulation. Sequence were randomized and patients were blinded in regards to the real/shame stimulation. We used 1 Hz frequency, total 600 pulses, target of stimulation was lateral right cerebellum. Before and after rTMS patients performed 2 motor tests with their fingers and hands (9 hole peg test, Test with balls). The duration of these tests was measured. Results: Test with balls in performance with right upper limb had significant difference (sig.dif.) (p=0.001) in comparison between before and after real rTMS (patients needed less time to complete the task after rTMS). This result remained if we subtracted influence of learning (change in sham rTMS) from real rTMS. And further there was sig.dif. (p=0.035) in change of test duration between real and sham stimulation too. 9 hole peg test had only one significant result - if we subtracted influence of learning from real rTMS, there was worsening after real rTMS as compared with time before rTMS (p=0.048). Patients needed more time after rTMS to complete this test. There was no adverse event in this study. Outcome: Low frequency repetitive transcranial magnetic stimulation of the right cerebellum (1 Hz, 600 pulses) is able to influence the right upper limb motor function for in patients with early-stage Parkinson’s disease. We have shown the acceleration of motor function of the upper limb in a test for grosser motor skills, and also observed slower motor function in a test for fine motor skills. References: [1]. Fierro B, Giglia G, Palermo A, Pecoraro C, Scalia S, Brighina F. Modulatory effects of 1 Hz rTMS over the cerebellum on motor cortex excitability. Exp Brain Res 2007; 176(3):440-7. [2]. Miall RC, Christensen LO, Cain O, Stanley J. Disruption of state estimation in the human lateral cerebellum. PLoS Biol 2007; 5(11):2733-44. [3]. Ugawa Y, Uesaka Y, Terao Y, Hanajima R, Kanazawa I. Magnetic stimulation over the cerebellum in humans. Ann Neurol 1995; 37(6):703-13. Supported by: MSM0021622404 eduard.minks@fnusa.cz
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