Effect of Theta-Burst Transcranial Magnetic Stimulation (TBS) for Freezing of Gait

Study Overview
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Brief Summary
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To investigate the treatment effect of Theta-burst Transcranial Magnetic Stimulation (TBS) on patients with freezing of gait (FOG) and the underlying neural mechanism.

Detailed Description
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This was a open-label clinical trial to assess the efficacy and underlying neural mechanism of TBS among patients with FOG. Forty patients with FOG were treated with TBS for 1 week. Before the TBS treatment, the Freezing of Gait Questionnaire, the Timed up and go test, the Standing Start 180° Turning Test, the Unified Parkinson's Disease Rating Scale, and the Non-motor Symptom Scale, the Pittsburgh sleep quality index were obtained by a trained investigator to assess baseline severity. The patients had receiving a battery measure of neuropsychological tests(mini-mental state examination, Montreal cognitive assessment, digital span test, verbal fluency test, Hamilton depression/anxiety scale) and magnetic resonance imaging (MRI) scan in multimodalities, and electroencephalography (EEG) record. In the second day after the last treatment, all the tests, MRI and EEG were reassessed. Patients were instructed to focus their answers on the past 1 week. The clinical symptom and cognition of participants were followed in one month and two month after the last treatment.

Official Title
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Effect of Theta-Burst Transcranial Magnetic Stimulation (TBS) for Freezing of Gait

Conditions
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Transcranial Magnetic Stimulation, Freezing of Gait

Intervention / Treatment
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* Device: Transcranial Magnetic Stimulation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: diagnosis of FOG with expertise in movement disorders. the score of item 3 of the FOG questionnaire ≥1. ongoing treatment with a stable dose of any medication for 2 months. 40 years of age or older. Exclusion Criteria: a history of addiction, psychiatric disorders, or neurological diseases other than PD. focal brain lesions on T1-/T2-weighted fluid-attenuated inversion recovery images. anti-PD medication adjustments during rTMS treatment. history of substance abuse within the past 6 months. nonremovable metal objects in or around the head. previously received rTMS treatment. prior history of seizure or history in first-degree relatives.

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TBS Group<br>Participants will receive active transcranial magnetic stimulation (TMS) daily for 1 week | Device: Transcranial Magnetic Stimulation<br>* The stimulations were performed by MagStim Rapid2.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Standing-Start 180° Turn Test (SS-180) | The participants walk for a distance of five meters from a sitting position and come back to the chair after turning 180° around a traffic cone in a 0.7 m × 0.7 m target box.The time and number of steps during the 180° turn (SS180) are measured. | changes from baseline to 1-week post-treatment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The timed up and go test (TUG) | The participants walk for a distance of five meters from a sitting position and come back to the chair after turning 180° around a traffic cone in a 0.7 m × 0.7 m target box .The time and number of steps during the whole course are measured. | changes from baseline to 1-week post-treatment | 
| The Freezing of Gait Questionnaire (FOGQ) | This is an very common clinical motor estimating scale for evaluating FOG symptoms with 6 items and 24' in total. Higher scores indicate worse symptoms. | changes from baseline to 1-week post-treatment | 
| Unified Parkinson's Disease Rating Scale III (UPDRSIII) | This is an very common clinical motor estimating scale, 14 items and 108' in total. Higher scores indicate worse symptoms. | changes from baseline to 1-week post-treatment | 
| Non-motor symptoms questionnaire | This is a very common clinical scale with nine domains (30 items). Each item was scored on severity range from 1 to 3 and frequency range from 1 to 4. Higher scores indicate worse symptoms. | changes from baseline to 1-week post-treatment | 
| HAMD (Hamilton Depression Scale) | This scale was compiled by Hamilton in 1960, is the most common clinical to assess Depression Scale. In this study, 17 versions were selected, and there were 17 questions. The subjects were assessed for their depression in the past week. Each question scored between 0 and 4 points.Higher scores indicate more depressive symptoms. | changes from baseline to 1-week post-treatment | 
| HAMA (Hamilton Anxiety Scale) | This scale was compiled by Hamilton in 1959.It was one of the most commonly used scales in psychiatric clinic, including 14 items. It is often used in clinical diagnosis and degree classification of anxiety disorder. The subjects were assessed for their anxiety in the past week. Each question scored between 0 and 4 points. The higher the score, the more symptoms of anxiety. | changes from baseline to 1-week post-treatment | 
| Pittsburgh sleep quality index (PSQI) | This scale was developed by Dr. Buysse et al., a psychiatrist at the University of Pittsburgh in 1989. The scale is suitable for the evaluation of sleep quality in patients with sleep disorders and mental disorders, as well as for the evaluation of sleep quality in general.Each question scored between 0 and 3 points.The higher the score, the worse sleep quality. | changes from baseline to 1-week post-treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transcranial Magnetic Stimulation, Freezing of gait