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Multiple sessions of low-frequency repetitive transcranial magnetic stimulation in focal hand dystonia: clinical and physiological effects

Article type: Research Article

Authors: Kimberley, Teresa Jacobson | Borich, Michael R. | Arora, Sanjeev | Siebner, Hartwig R.

Affiliations: Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, USA | Danish Research Center for Magnetic Resonance, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark

Note: [] Corresponding author: Teresa Jacobson Kimberley, PhD, PT, University of Minnesota, Program in Physical Therapy, MMC 388 426 Church St SE Minneapolis, MN 55455, USA. Tel.: +1 612 626 4096; Fax: +1 612 625 4274; E-mail: [email protected]

Keywords: Focal hand dystonia, rehabilitation, rTMS, writer's cramp, clinical

DOI: 10.3233/RNN-120259

Journal: Restorative Neurology and Neuroscience, vol. 31, no. 5, pp. 533-542, 2013

Published: 2013
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Abstract

Purpose: The ability of low-frequency repetitive transcranial magnetic stimulation (rTMS) to enhance intracortical inhibition has motivated its use as a potential therapeutic intervention in focal hand dystonia (FHD). In this preliminary investigation, we assessed the physiologic and behavioral effects of multiple sessions of rTMS in FHD. Methods: 12 patients with FHD underwent five daily-sessions of 1 Hz rTMS to contralateral dorsal premotor cortex (dPMC). Patients held a pencil and made movements that did not elicit dystonic symptoms during rTMS. We hypothesized that an active but non-dystonic motor state would increase beneficial effects of rTMS. Five additional patients received sham-rTMS protocol. The area under curve (AUC) of the motor evoked potentials and the cortical silent period (CSP) were measured to assess changes in corticospinal excitability and intracortical inhibition, respectively. Behavioral measures included pen force and velocity during handwriting and subjective report. Results: Multiple-session rTMS strengthened intracortical inhibition causing a prolongation of CSP after 3 days of intervention and pen force was reduced at day 1 and 5, leaving other measures unchanged. 68% of patients self-reported as ‘responders’ at day 5, and 58% at follow-up. Age predicted responders. Conclusions: A strong therapeutic potential of this rTMS paradigm in FHD was not supported but findings warrant further investigation.

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