Neurotherapeutics

, Volume 5, Issue 2, pp 345–361

Noninvasive brain stimulation for Parkinson’s disease and dystonia

Authors

  • Allan D. Wu
    • Department of NeurologyUniversity of California
    • Ahmanson-Lovelace Brain Mapping CenterUniversity of California
  • Felipe Fregni
    • Department of NeurologyBeth Israel Deaconess Medical Center
    • Berenson-Allen Center for Noninvasive Brain StimulationBeth Israel Deaconess Medical Center and Harvard Medical School
  • David K. Simon
    • Department of NeurologyBeth Israel Deaconess Medical Center
    • Berenson-Allen Center for Noninvasive Brain StimulationBeth Israel Deaconess Medical Center and Harvard Medical School
  • Choi Deblieck
    • Department of NeurologyUniversity of California
    • Ahmanson-Lovelace Brain Mapping CenterUniversity of California
    • Department of NeurologyBeth Israel Deaconess Medical Center
    • Berenson-Allen Center for Noninvasive Brain StimulationBeth Israel Deaconess Medical Center and Harvard Medical School
    • Institut Guttmann for NeurorehabilitationUniversitat Autònoma
Noninvasive DBS

DOI: 10.1016/j.nurt.2008.02.002

Cite this article as:
Wu, A.D., Fregni, F., Simon, D.K. et al. Neurotherapeutics (2008) 5: 345. doi:10.1016/j.nurt.2008.02.002

Summary

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are promising noninvasive cortical stimulation methods for adjunctive treatment of movement disorders. They avoid surgical risks and provide theoretical advantages of specific neural circuit neuromodulation. Neuromodulatory effects depend on extrinsic stimulation factors (cortical target, frequency, intensity, duration, number of sessions), intrinsic patient factors (disease process, individual variability and symptoms, state of medication treatment), and outcome measures. Most studies to date have shown beneficial effects of rTMS or tDCS on clinical symptoms in Parkinson’s disease (PD) and support the notion of spatial specificity to the effects on motor and nonmotor symptoms. Stimulation parameters have varied widely, however, and some studies are poorly controlled. Studies of rTMS or tDCS in dystonia have provided abundant data on physiology, but few on clinical effects. Multiple mechanisms likely contribute to the clinical effects of rTMS and tDCS in movement disorders, including normalization of cortical excitability, rebalancing of distributed neural network activity, and induction of dopamine release. It remains unclear how to individually adjust rTMS or tDCS factors for the most beneficial effects on symptoms of PD or dystonia. Nonetheless, the noninvasive nature, minimal side effects, positive effects in preliminary clinical studies, and increasing evidence for rational mechanisms make rTMS and tDCS attractive for ongoing investigation.

Key Words

Parkinson’s diseasedystoniatranscranial magnetic stimulationtranscranial direct current stimulationcortical stimulation
Download to read the full article text

Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2008