Effects of the association a neuromodulation protocol and motor training protocol on motor impairment in different Parkinson's Disease phenotypes.

Amanda Bezerra da Silva¹, Brenda Jucene², Rebeca Dias³, Rodrigo Brito⁴, Adriana Baltar⁵, Lívia Shirahige⁶, Kátia Monte-Silva⁷

  1. Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.; 2. Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. 3. Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. Postgraduate Program in Physical therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. ;⁴ Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; ⁵ Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. PhD in Neuropsychiatry and Behavioral Sciences.; ⁶ Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.; ⁷ Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. Adjunct Professor, Department of Physiotherapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil. Corresponding author: Katia Monte-Silva

OBJECTIVE: To evaluate the effects of the repetitive Transcranial Magnetic Stimulation (rTMS) protocol combined with motor training on Motor Impairement (MI) in different Parkinson's disease phenotypes.

METHODS: Clinical trial, randomized, triple blind and controlled sham study (CEP: 2,419,037 and NTC03645538) including PD patients, classified according sections II and III of the Unified Parkinson's Disease Rating Scale (UPDRS), in Tremor Dominant (TD) (n=8;Disease time: 69±21,2 meses; Levodopa Equivalent Dose  (LED): 746,63±295,5)or Postural Instability/Gait Difficulty (PIGD) (n=8; Disease time: 73,75±86,0; LED: 707,50±202,9) phenotypes. MI was evaluated, before and after 5 consecutive sessions (baseline and T0, respectively), with patients under the effect of dopaminergic medication, measured through the total scores of UPDRS III and the subsection bradykinesia, with higher scores means  worsen motor impairment. The patients were randomized in two groups: (i) rTMS real protocol (1000 pulses, 10Hz, 20 trains, 50 pulses/train, 30-second interval intertrain, 100% of motor threshold); (ii) or sham rTMS. The rTMS were applied at points C3, C4 and Cz. Motor training occurred after stimulation. The results will be expressed in percentage measures between the baseline and T0 scores.

RESULTS: The TD group had a significant increase in MI (Total UPDRS: -23.1%; Bradykinesia subsection: -36.7%). The PIGD group had a MI decline (Total UPDRS: 5.0%; Subsection Bradykinesia: 14.2%).

CONCLUSIONS: The effects of the same neuromodulation protocol are different from depend on the patient's TD or PIGD clinical phenotype.

FIGURE. Graphs showing the percentage of change in the total UPDRS III scores and bradykinesia subsection between baseline and T0.

The ordinates corresponding to the arithmetic means of the total UPDRS scores (left) and the Bradykinesia subsection (right). TD: dominant tremor; PIGD: Postural instability / Difficulty walking; UPDRS: Unified Parkinson's Disease Assessment Scale; Baseline and T0: before and after the fifth session of the intervention, respectively.

KEYWORDS: Parkinson’s Disease, Transcranial Magnetic Stimulation, Sensorimotor Performance

ACKNOWLEDGMENTS: The researchers were supported by the Fundação de Amparo à Ciência e Tecnologia de Pernambuco (FACEPE), Brazil. Monte-Silva K receives a grant (308291/2015-8) from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil. Lívia Shirahige receives a grant (IBPG-1548-4.01/16) from FACEPE. Amanda Bezerra da Silva receives a grant (120289 / 2020-2) from CNPq. Brenda Jucene receives a grant (147995 / 2019-1) from CNPq.

FUNDING/FINANCIAL SUPPORT: None

DOI: https://doi.org/10.21801/ppcrj.2020.S1.33