Title: Repetitive Transcranial Magnetic Stimulation For Freezing Of Gait And Motor Function In Parkinson’s Disease: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials
Authors: Jamir Pitton Rissardo and Ana Leticia Fornari Caprara
Conference: 2025 International Congress of Parkinson's Disease, Honolulu, HI
Objective
To evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on motor function, freezing of gait (FOG), and mobility in patients with Parkinson’s disease (PD).
Background
Freezing of gait and mobility impairments are common and disabling symptoms in PD. Repetitive transcranial magnetic stimulation (rTMS) has emerged as a potential non-invasive neuromodulatory therapy targeting motor and gait-related circuits. However, the efficacy of different rTMS frequencies and protocols in improving motor symptoms and gait function remains uncertain.
Methods
A systematic review and meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials (RCTs) investigating rTMS in PD patients were identified through the PubMed database. Outcomes assessed included changes in the Unified Parkinson’s Disease Rating Scale Part III (UPDRS-III), Freezing of Gait Questionnaire (FOG-Q), Timed Up & Go (TUG) test, and walking speed. Standardized mean differences (SMD) and mean differences with 95% confidence intervals (CI) were analyzed using a random-effects model.
Results
Five RCTs (PMID: 33314545, 34102418, 31275542, 31689588, 23516319) met the inclusion criteria, encompassing a total of 140 patients receiving rTMS and 116 receiving sham stimulation. Across studies, rTMS demonstrated varying effects based on stimulation frequency. Continuous theta burst stimulation (cTBS) produced the greatest improvement in motor function, with a mean difference in UPDRS-III scores of -8.50 (95% CI: -9.74, -7.26). High-frequency rTMS showed moderate effects on UPDRS-III (-4.40 to -3.35), while low-frequency stimulation demonstrated less consistent improvements (-5.47 to -1.50). FOG-Q scores showed a trend toward improvement, with reductions of -3.09 (95% CI: -8.15, 1.97) and -2.77 (95% CI: -6.15, 0.61) in studies using low- and high-frequency rTMS, respectively. TUG test performance improved following high-frequency rTMS (mean difference: -3.33 seconds, 95% CI: -5.45, -1.21), while walking speed changes were variable (range: 0.37 to 0.49 m/s improvement).
Conclusions
rTMS, particularly continuous theta burst and high-frequency stimulation, demonstrated moderate improvements in motor function and mobility in PD patients. Effects on freezing of gait were less consistent, suggesting the need for further research to optimize stimulation parameters and identify responders.
Citation
Pending
Figure. Forest and Baujat plots of the effect of repetitive magnetic stimulation on UPDRS-III in Parkinson's disease.