eprintid: 10073873 rev_number: 20 eprint_status: archive userid: 608 dir: disk0/10/07/38/73 datestamp: 2019-05-15 16:01:01 lastmod: 2021-09-20 00:33:28 status_changed: 2019-05-15 16:01:01 type: article metadata_visibility: show creators_name: Khedr, EM creators_name: Al-Fawal, B creators_name: Wraith, AA creators_name: Saber, M creators_name: Hasan, AM creators_name: Bassiony, A creators_name: Eldein, AN creators_name: Rothwell, JC title: The Effect of 20 Hz versus 1 Hz Repetitive Transcranial Magnetic Stimulation on Motor Dysfunction in Parkinson’s Disease: Which Is More Beneficial? ispublished: inpress subjects: UCH divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F84 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: BACKGROUND: There is evidence that both high and low frequency rTMS may have therapeutic effects on motor performance of Parkinson's disease. OBJECTIVE: The aim of the study was to conduct the first direct comparison of the two approaches. METHODS: 52 PD patients were randomly classified into two groups. The first group received 20 Hz and the 2nd group received 1 Hz rTMS with a total of 2000 pulses over M1of each hemisphere for ten days. Effects were assessed with the Unified Parkinson's Disease Rating Scale part III (UPDRS), Instrumental Activity of Daily Living (IADL), and a self-assessment score (SA) before, after the last session, and one month later. Cortical excitability was measured before and after the end of sessions. RESULTS: There was a significant improvement on all rating scales after either 1 Hz or 20 Hz rTMS, but the effect persisted for longer after 20 Hz (treatment X time interaction for UPDRS and IADL (P = 0.075 and 0.04, respectively). Neither treatment affected motor thresholds, but 20 Hz rTMS increased MEP amplitude and the duration of transcallosal inhibition. In an exploratory analysis, each group was subdivided into akinetic-rigid and tremor dominant subgroups and the effects of 1 Hz and 20 Hz treatment recalculated. There was weak evidence that patients with an akinetic-rigid presentation may respond better than those with predominant tremor. CONCLUSION: Both 20 Hz and 1 Hz rTMS improve motor function in PD, but 20 Hz rTMS is more effective. date: 2019-03-21 date_type: published official_url: http://doi.org/10.3233/JPD-181540 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green article_type_text: Journal Article verified: verified_manual elements_id: 1644155 doi: 10.3233/JPD-181540 pii: JPD181540 language_elements: English lyricists_name: Rothwell, John lyricists_id: JCROT52 actors_name: Rothwell, John actors_id: JCROT52 actors_role: owner full_text_status: public publication: Journal of Parkinson's Disease event_location: Netherlands issn: 1877-718X citation: Khedr, EM; Al-Fawal, B; Wraith, AA; Saber, M; Hasan, AM; Bassiony, A; Eldein, AN; Khedr, EM; Al-Fawal, B; Wraith, AA; Saber, M; Hasan, AM; Bassiony, A; Eldein, AN; Rothwell, JC; - view fewer <#> (2019) The Effect of 20 Hz versus 1 Hz Repetitive Transcranial Magnetic Stimulation on Motor Dysfunction in Parkinson’s Disease: Which Is More Beneficial? Journal of Parkinson's Disease 10.3233/JPD-181540 <https://doi.org/10.3233/JPD-181540>. (In press). Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10073873/3/Rothwell_The%20Effect%20of%2020%20Hz%20versus%201%20Hz%20Repetitive%20Transcranial%20Magnetic%20Stimulation%20on%20Motor%20Dysfunction%20in%20Parkinson%E2%80%99s%20Disease_AAM.pdf