Repetitive Transcranial Magnetic Stimulation (rTMS) for Dystonia and Tremor

Study Overview
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Brief Summary
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The study will include subjects diagnosed with Dystonic Tremor (DT), Essential Tremor (ET), and healthy controls in the age range of 21-80 years. Electroencephalography (EEG) will be used as the primary outcome measure. Transcranial Magnetic Stimulation (TMS) will be used over the motor cortices or cerebellar cortices as an intervention that is expected to have short-term (less than an hour) electrophysiological effects.

Detailed Description
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The primary goal of this study is to compare differences in cortical activity of patients with tremor before and after applying a session of rTMS. Specifically, the investigators will apply rTMS to the primary motor cortex (M1) as our group and others have shown abnormal function of the region. Moreover, a study shows that targeting of M1 and the dorsal premotor cortex (dPMC) with rTMS results in a trend towards improved clinical outcome in patients with focal hand dystonia and cervical dystonia. The central hypothesis of this study is that rTMS can modify cortical oscillations in patient populations with tremor and that the investigators will be able to detect these changes with the use of Electroencephalography (EEG). By applying inhibitory rTMS to the motor cortices, the investigators may expect a shift in cortical oscillations towards normal activity.

Official Title
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Changes in Cortical Oscillations Induced by Repetitive Transcranial Magnetic Stimulation (rTMS) Therapy in Patient Populations With Tremor

Conditions
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Dystonia, Tremor

Intervention / Treatment
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* Device: repetitive Transcranial Magnetic Stimulation (rTMS)
* Other: Control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for Dystonia and/or tremor: - Diagnosis of Dystonia and/or tremor according to the Consensus Statement of the Movement Disorders Society Exclusion Criteria Dystonia and/or tremor: Pregnancy Active seizure disorder Presence of a metallic object such as a pacemaker, implants, metal rods, and hearing aid History of stroke Inclusion Criteria for Healthy controls - There is no history of any neurological disorders. Exclusion Criteria for Healthy controls Pregnancy Any neurological disorders Presence of a metallic body in their brain History of stroke

Ages Eligible for Study
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Minimum Age: 21 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dystonia and/or tremor<br>Adults with a diagnosis of dystonia and/or tremor | Device: repetitive Transcranial Magnetic Stimulation (rTMS)<br>* Repetitive transcranial magnetic stimulation (rTMS) is a form of brain stimulation therapy using a magnet to target and stimulate certain areas of the brain.<br>|
| Experimental: Control<br>Healthy adults without a history of any neurological disorder, with a similar age distribution and sex ratio as the dystonia and/or tremor group | Other: Control group<br>* No application of rTMS<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cognitive Assessment Using MoCA Version 7.1 Scores | Montreal Cognitive Assessment Version 7.1 was used to assess cognitive ability. This scales is score from a range of 0 to 30 with a score of 24 or less indicating mild cognitive impairment. Moderate cognitive impairment is indicated by a score of 18-23 and severe impairment is a score of 10 or less. Overall, a higher number indicates better cognitive ability. | Day 1 |