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Theta burst stimulation over the supplementary motor area in Parkinson’s disease

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Abstract

To investigate whether a period of continuous theta burst stimulation (cTBS) over the supplementary motor area (SMA) induces cortical plasticity and thus improves bradykinesia in Parkinson’s disease (PD) in the medication ON and OFF state. In total, 26 patients with Parkinson’s disease were tested with both real and sham stimulation. The group was divided into an OFF-medication (4 females, mean age 65 years, disease duration 6 years) and an ON-medication group (7 females, mean age 61 years, disease duration 7 years) with each containing 13 individuals. Both groups were evaluated in terms of electrophysiological (motor-evoked potentials) and behavioural [Purdue Pegboard test (PPT), UPDRS motor subscore] parameters before (baseline condition) and after a 40-second period of real or sham continuous theta burst stimulation over the SMA ON and OFF dopaminergic drugs. Patients in the OFF group demonstrated an improved UPDRS III score (p < 0.05) and a better performance in the PPT for the less affected side (p < 0.025) compared to baseline after real stimulation. However, electrophysiological parameters did not change in either the ON or the OFF state. cTBS over the SMA has a mild effect on motor symptoms of the upper limb in the OFF state of PD patients. In contrast, stimulation did not change cortico-spinal excitability. A lack of change (i.e. no plasticity) to brain stimulation protocols is a known finding in PD. A clinical improvement in the OFF state, however, contrasts with this and the mechanism of these induced changes is worth further exploration.

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Acknowledgments

This study was supported by a grant of the “Felgenhauer-Stiftung zur Förderung junger Neurowissenschaftler”.

Conflicts of interest

C.E. occasionally received honoraria from Medtronic Inc., TEVA Pharma and UCB Pharma for lecturing at conferences or consulting work. The institution of C.E., not C.E. personally received funding by the German Research Foundation (DFG), Köln Fortune, Medtronic Inc., Bayer Healthcare, UCB Pharma, Abbott and Zur Rose Pharma. M.G. did not report any disclosures. J.R. has no disclosures relevant to this manuscript. L.T. received payments as a consultant for Medtronic Inc., Boston Scientific, Bayer Healthcare, UCB Schwarz Pharma and Sapiens. L.T. received honoraria as a speaker on symposia sponsored by TEVA Pharma, Lundbeck Pharma, Bracco, Gianni PR, Medas Pharma, UCB Schwarz Pharma, Desitin Pharma, Boehringer Ingelheim, GlaxoSmithKline, Eumecom, Orion Pharma, Medtronic Inc., Boston Scientific, Cephalon, Abott, GE Medical. The institution of L.T., not L.T. personally, received funding by the German Research Foundation (DFG), the German Ministry of Education and Research, Manfred und Ursula Müller Stiftung, Klüh Stiftung, Hoffnungsbaum e. V., NBIA DISORDERS SOCIETY USA, Köln Fortune, Medtronic Inc., UCB Schwarz Pharma, Bayer Healthcare, zur Rose Pharma, Abbvie, Archimedes Teva and Deutsche Parkinson Vereinigung. D.R. has no disclosures relevant to this manuscript.

Ethical standard

This study has been approved by the local ethics committee (approval number EK 09-235) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Authors and Affiliations

  1. Department of Neurology, University Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany

    Carsten Eggers, Miriam Günther & Lars Timmermann

  2. Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK

    Carsten Eggers, John Rothwell & Diane Ruge

Authors
  1. Carsten Eggers
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  2. Miriam Günther
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Correspondence to Carsten Eggers.

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Eggers, C., Günther, M., Rothwell, J. et al. Theta burst stimulation over the supplementary motor area in Parkinson’s disease. J Neurol 262, 357–364 (2015). https://doi.org/10.1007/s00415-014-7572-8

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  • DOI: https://doi.org/10.1007/s00415-014-7572-8

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