To determine the efficacy and duration of benefit of noninvasive brain stimulation with repetitive transcranial magnetic stimulation (rTMS) to modulate brain activity in order to improve motor and mood symptoms in Parkinson's disease.
At four leading centers in North America (Beth Israel Deaconess Medical Center-Harvard Med School in Boston, University of Florida in Gainesville, University of California in Los Angeles and Toronto Western Research Institute-University of Toronto, Canada) we will study a total of 160 patients with idiopathic PD. Patients will have significant motor problems despite treatment with medications and meet criteria for a depressive disorder.
Patients will be randomly assigned to one of four treatment groups that will differ in the form of rTMS applied. Stimulation will target one or both of two brain regions involved in motor or mood symptoms. Each patient will receive 10 daily sessions of rTMS over two weeks. We predict that rTMS will improve motor symptoms, depression, or both, depending on which regions are stimulated.
Relevance to Diagnosis/Treatment of Parkinson’s Disease:
In addition to the motor symptoms, a variety of non-motor symptoms, including cognitive problems and mood disorders, critically contribute to the disability of PD. Depression is very common in PD, and plays a major role in the morbidity, disability, and impaired quality of life of PD. Evidence suggests that depression in PD is not merely a response to chronic illness or motor impairments, but results from different factors related to the degenerative brain process itself. Treatment of both motor symptoms and depression is thus essential to optimize quality of life and minimize disability in PD. With the increasing use of rTMS as a treatment for major depression, this study will address how rTMS can be used to help treat depression in PD patients and whether rTMS may also help motor symptoms at the same time.
We propose a novel, non-invasive and safe treatment to modulate brain activity in order to improve motor function and control depressive symptoms in PD. If successful, rTMS will become a valuable adjunct to other therapeutic options in PD.