Magnetic Stimulation for Parkinson Disease
Condition: Parkinson's Disease; Depression
MeSH terms: Parkinson Disease; Depression; Depressive Disorder
Study type: Interventional
Phase: Phase 1

Summary: 
      During transcranial magnetic stimulation (TMS), a magnetic coil is placed on the front part
      of the head. Electric current passes through the coil in brief pulses. Magnetism from the
      current produces a separate, small electric current inside the brain, which activates brain
      cells below the coil. This treatment may result in decreased depression and improved
      Parkinson's disease symptoms.
    

Detailed description: 
      The major aim of this study is to carry out a sequential Phase I trial of prefrontal
      transcranial magnetic brain stimulation (TMS) and electroconvulsive therapy (ECT) in patients
      with Parkinson's disease (PD) and severe depression. Depression complicates PD in up to 50%
      of cases, leading to further deterioration of motor performance and quality of life; but
      antidepressant medication fails or produces intolerable side effects in 25-30% of patients.
      Case reports and uncontrolled trials suggest that ECT is effective in ameliorating
      simultaneously the mood and motor symptoms of PD. Only a few small studies of ECT in PD have
      been prospective or randomized, the assessment protocols have been limited, and the results
      have been variable. TMS is a new, promising, alternative treatment for refractory depression,
      which appears to be easier and safer than ECT. Requiring no hospitalization, anesthesia, or
      recovery time, TMS is now being investigated as an alternative therapy for mood disorders.
      TMS has not been studied in depressed patients with PD or in other serious central nervous
      system diseases.

      This study extends our past and present research in PD, depression, ECT, and TMS. We will
      comprehensively evaluate the effects of left prefrontal TMS on mood, motor, and
      neuropsychological function, together with quality of life indices in depressed PD patients.
      All patients will initially receive treatment with TMS. Those who fail to benefit will
      proceed to ECT. Comprehensive evaluation will be continued for another eight weeks in both
      the TMS-only and ECT groups. The key issues addressed by these studies include: (1) the
      potential benefit of TMS on mood and movement in depressed PD patients, and (2) the tightness
      of the association between mood and motor function after TMS and ECT. Overall, these studies
      will provide important preliminary data on the relationships among mood, cognitive and motor
      function in PD, and their influence on quality of life. The results will help in directing
      future applications of TMS as an alternative therapy for brain disorders, and will further
      elucidate the relative benefits of both TMS and ECT in depressed PD patients. A positive
      effect from TMS should be an impetus towards randomized, placebo-controlled trials.
    

Intervention name(s): Prefrontal transcranial magnetic brain stimulation
Intervention type(s): Procedure
Allocation: Non-Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Parkinson's; Depression; Magnetic Stimulation