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<h5 class="section-title" id="d9072847e147">Objective</h5>
<p id="P1">Several studies have reported repetitive transcranial magnetic stimulation
(rTMS)
therapy as an effective treatment for the control of motor symptoms in Parkinson disease.
The objective of the study is to quantify the overall efficacy of this treatment.
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<h5 class="section-title" id="d9072847e152">Types</h5>
<p id="P2">Systematic review and meta-analysis.</p>
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<h5 class="section-title" id="d9072847e157">Literature survey</h5>
<p id="P3">We reviewed the literature on clinical rTMS trials in Parkinson disease
since the
technique was introduced in 1980. We used the following databases: MEDLINE, Web of
Science, Cochrane, and CINAHL.
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<h5 class="section-title" id="d9072847e162">Methodology</h5>
<p id="P4">Patients and setting: Patients with Parkinson disease who were participating
in prospective
clinical trials that included an active arm and a control arm and change in motor
scores on Unified Parkinson’s Disease Rating Scale as the primary outcome. We pooled
data from 21 studies that met these criteria. We then analyzed separately the effects
of low- and high-frequency rTMS on clinical motor improvements.
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<h5 class="section-title" id="d9072847e167">Synthesis</h5>
<p id="P5">The overall pooled mean difference between treatment and control groups
in the Unified
Parkinson’s Disease Rating Scale motor score was significant (4.0 points, 95% confidence
interval, 1.5, 6.7;
<i>P</i> = .005). rTMS therapy was effective when low-frequency stimulation (≤ 1 Hz)
was used
with a pooled mean difference of 3.3 points (95% confidence interval 1.6, 5.0;
<i>P</i> = .005). There was a trend for significance when high-frequency stimulation
(≥5 Hz)
studies were evaluated with a pooled mean difference of 3.9 points (95% confidence
interval, −0.7, 8.5;
<i>P</i> = .08). rTMS therapy demonstrated benefits at short-term follow-up (immediately
after
a treatment protocol) with a pooled mean difference of 3.4 points (95% confidence
interval, 0.3, 6.6;
<i>P</i> = .03) as well as at long-term follow-up (average follow-up 6 weeks) with
mean difference
of 4.1 points (95% confidence interval, −0.15, 8.4;
<i>P</i> = .05). There were insufficient data to statistically analyze the effects
of rTMS
when we specifically examined bradykinesia, gait, and levodopa-induced dyskinesia
using quantitative methods.
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<h5 class="section-title" id="d9072847e187">Conclusion</h5>
<p id="P6">rTMS therapy in patients with Parkinson disease results in mild-to-moderate
motor
improvements and has the potential to be used as an adjunct therapy for the treatment
of Parkinson disease. Future large, sample studies should be designed to isolate the
specific clinical features of Parkinson disease that respond well to rTMS therapy.
</p>
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