Low frequency rTMS of the SMA transiently ameliorates peak-dose LID in Parkinson's disease

Objective:To determine whether low-frequency repetitive transcranial magnetic stimulation (rTMS) may modulateL-DOPA-induceddyskinesia (LID) in dyskinetic Parkinson’s disease (PD) patients.LID is a severe motor complication in advanced PD patients. The neural mechanisms involved in LID are not clear, and it is apparentthat both an excessive decrease in internal pallidus firing and a modification and overactivation of cortical motor and premotor areas areinvolved in its pathogenesis.Methods:Using low frequency 1 Hz repetitive rTMS we investigated whether decrease of excitability of the supplementary motor area(SMA) may result in modification of LID in PD patients. Furthermore we tested whether it was possible to enhance and/or prolong thebeneficial effects of the treatment with repeated sessions of stimulation.Results:We observed that 1 Hz rTMS induced a transient reduction of dyskinesias. A single session of rTMS improved LID, whilerepeated sessions of stimulation failed to enhance and/or prolong the beneficial effects of the procedure, without causing motor deteri-oration or other adverse effects.Conclusions:These results suggest that LID may depend on an increased excitability of the SMA.Significance:SMA rTMS is effective in reducing transiently LID, although cannot yet be considered clinically useful.