Combination of rTMS and treadmill training modulates corticomotor inhibition and improves walking in Parkinson disease: a randomized trial.

Background: Repetitive transcranial magnetic stimulation (rTMS) of the brain has been shown to modulate cortical excitability. Combinations of rehabilitation therapies with rTMS might enhance the therapeutic effects.

Objective: The purpose of this study was to investigate the effects of high-frequency rTMS followed by treadmill training on cortical inhibition and walking function in individuals with Parkinson disease (PD).

Methods: A total of 20 patients with PD were randomized into an experimental group and a control group. Participants received rTMS (experimental group) or sham rTMS (control group) followed by treadmill training (30 minutes) for 12 sessions over 4 weeks. Repetitive TMS was applied at a 5-Hz frequency over the leg area of the motor cortex contralaterally to the more affected side for 6 minutes. Outcomes, including corticomotor inhibition and walking performance, were measured before and after training.

Results: . The results showed significant time effects on almost all corticomotor and functional variables. There are significant interaction effects between group and time of evaluation on the motor threshold, duration of the cortical silent period, and short interval intracortical inhibition of the contralateral hemisphere relatively to the more affected side as well as on the fast walking speed and timed up and go.

Conclusions: The findings suggested that combination of rTMS and treadmill training enhances the effect of treadmill training on modulation of corticomotor inhibition and improvement of walking performance in those with PD.