fMRI-guided TMS for treatment of PD

An Exciting New Therapy for Parkinson’s

Application of rTMS has shown to have a positive effect in patients with Parkinson’s disease (PD). Studies reporting the use of TMS while monitoring various symptoms of Parkinson’s such as gait or hand function have shown significant improvement in these symptoms[Mi]. These studies have revealed that high frequency rTMS delivered to the motor areas of the cortex improves motor scores. Some of these studies have shown sustained improvements for up to a month after treatment ended. Improvements caused by TMS were reflected in bradykinesia or dyskinesia scores. It has also been reported improvement in gait speed from rTMS treatment. In this study [Lee] gait speed improved after a single session of high frequency rTMS. Further, gait speed improvements were reported in conjunction with reductions in bradykinesia following rTMS treatments over the course of a month persisted for at least a month following intervention [Lomarev].

Functional MRI(fMRI) has also been used to assess high frequency rTMS delivered to the primary motor cortex [Gonzalez].Use of fMRI enabled showing reductions in bradykinesia following 3 months of rTMS treatment and furthermore, the improvement was correlated with activity in the caudate.  Such tools provide evidence for TMS ability to induce plastic changes to subcortical structures of the brain. Therefore, it is natural that when using fMRI to guideTMS treatments, one could bring the power of these two powerful technologies to provide more benefits to Parkinson’s as measured in gait speed parameters.  This is exactly what Neurotherapeutix has done.

Parkinson's Disease Patient at Baseline

The benefits of rTMS on motor function in Parkinson’s and gait performance indicate that improvements depend on the location of high frequency rTMS stimulation. For example, observation of motor improvement due to application of rTMS over the primary motor cortex and low frequency rTMS over the supplementary motor, regardless of medication, suggests that rTMS may be an effective treatment for management of motor symptoms. Our fMRI guided TMS using brain connectivity mapping offer a sensitive tool to personalize treatments by selecting specific brain regions involved in the disease, and to monitor improvements by assessing changes in brain connectivity after treatments.

Furthermore, our use of network neuroscience to guide our diagnosis and treatment of PD patients has helped us to understand the abnormal brain connectivity. We have used resting-state fMRI (rsfMRI) to show PD as a consequence of the disruptions in several networks.  Research has also shown this model using diffusion tensor imaging (DTI) [ Lopes], rsfMRI [Luo] and PET imaging [Brooks]. Many studies on brain network of PD patients have revealed disruptions in the brain networks, which can serve as biomarkers of PD for clinical diagnosis [Amboni] and treatment. At Neurotherapeutix, we offer the use of modular organization of functional brain networks in PD patients as a measure of abnormal functional integration of PD and treat patients based on the network model.

References

1. Mi TM, Garg S, Ba F, Liu AP, Liang PP, Gao LL, Jia Q, Xu EH, Li KC, Chan P, McKeown MJ. Repetitive transcranial magnetic stimulation improves Parkinson’s freezing of gait via normalizing brain connectivity. NPJ Parkinson’s disease. 2020 Jul 17;6(1):1-9.

2. Lee SY, Kim MS, Chang WH, Cho JW, Youn JY, Kim YH. Effects of repetitive transcranial magnetic stimulation on freezing of gait in patients with Parkinsonism. Restorative neurology and neuroscience. 2014 Jan 1;32(6):743-53.

3. Lomarev MP, Kanchana S, Bara‐Jimenez W, Iyer M, Wassermann EM, Hallett M. Placebo‐controlled study of rTMS for the treatment of Parkinson’s. Movement Disorders. 2006 Mar 1;21(3):325-31

4. González-García N, Armony JL, Soto J, Trejo D, Alegría MA, Drucker-Colín R. Effects of rTMS on Parkinson’s disease: a longitudinal fMRI study. Journal of neurology. 2011 Jul 1;258(7):1268-80.

5. Chou Y, Hickey PT, Sundman M, Song AW, Chen N. Effects of Repetitive Transcranial Magnetic Stimulation on Motor Symptoms in Parkinson Disease: A Systematic Review and Meta-analysis. JAMA Neurology. 2015; 72:432-440.

6. Thakral PP, Madore KP, Kalinowski SE, Schacter DL. Modulation of hippocampal brain networks produces changes in episodic simulation and divergent thinking. Proc Natl Acad Sci U S A. 2020 Jun 9;117(23):12729-12740. doi: 10.1073/pnas.2003535117. Epub 2020 May 26. PMID: 32457143; PMCID: PMC7293701.

7. Lopes, R., Delmaire, C., Defebvre, L., Moonen, A. J., Duits, A. A., Hofman, P., et al. (2017). Cognitive phenotypes in parkinson’s disease differ in terms of brain-network organization and connectivity. Hum. Brain Mapp. 38, 1604–1621. doi: 10.1002/hbm.23474

8. Luo, C. Y., Song, W., Chen, Q., Zheng, Z. Z., Chen, K., Cao, B., et al. (2014). Reduced functional connectivity in early-stage drug-naive parkinson’s disease: a resting-state fMRI study. Neurobiol. Aging 35, 431–441. doi: 10.1016/j.neurobiolaging.2013.08.018

9. Amboni, M., Tessitore, A., Esposito, F., Santangelo, G., Picillo, M., Vitale, C., et al. (2015). Resting-state functional connectivity associated with mild cognitive impairment in parkinson’s disease. J. Neurol. 262, 425–434. doi: 10.1007/s00415-014-7591-5

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Neurotherapeutix is the leading clinic for functional imaging guided transcranial magnetic stimulation (TMS), a safe, innovative, and non-invasive methodology for treating a wide range of acute and chronic mental disorders and brain injuries. Our advanced fMRI technology allows us to map the brain for the… Learn More »

Published: March 24, 2023NYC

Last Reviewed: January 10, 2024

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