Personalized Repetitive Transcranial Magnetic Stimulation to Improve Walking in Parkinsons Disease Patients Aged 50 and Older

What this Trial Is About

Researchers are investigating the effects of different repetitive transcranial magnetic stimulation rTMS therapy protocols tailored to the functional reserve of patients with Parkinsons disease. The study compares these personalized protocols with the conventional high-frequency rTMS therapy applied to the bilateral primary motor cortex M1. The goal is to see if customizing the stimulation based on motor or cognitive functional reserve leads to better motor function recovery and ambulatory improvement in people with Parkinsons disease. Participants are first assessed using the Timed Up and Go Test TUG and Timed Up and Go Dual Task-Cognitive TUG-Cog to classify them as having either motor or cognitive priority functional reserve. Based on this, they are randomly assigned to one of four groups motor priority patients receive either high-frequency rTMS over the more affected primary motor cortex or bilateral M1 of the lower extremities, while cognitive priority patients receive high-frequency rTMS over the left dorsolateral prefrontal cortex DLPFC or bilateral M1. Each participant undergoes 20 sessions of 10-Hz rTMS at 90% resting motor threshold, five days a week for four weeks, followed by treadmill gait training and routine Parkinsons disease pharmacotherapy. Throughout the study, participants mobility and motor functions are evaluated using various tests including the Timed Up and Go Test TUG, TUG-Cog, Movement Disorder Society-Unified Parkinsons Disease Rating Scale MDS-UPDRS, and Freezing of Gait Questionnaire FoG-Q. Additional assessments involve cognitive tests like the Digit Span Test and Trail Making Test, as well as gait lab parameters such as speed, stride length, and pressure distribution. These measures are taken at baseline, during intervention, post-intervention, and two months after to monitor changes. Safety, efficacy, and the impact on ambulatory function are carefully tracked over the study period.

Personalized rTMS Protocol Based on Functional Reserve to Enhance Ambulatory Function in PD Patients