Background: There are inconsistent data on the efficacy of bilateral repetitive transcranial magnetic stimulation (rTMS) over the motor cortex on depression associated with Parkinson's disease (PD). Therefore, we conducted a randomized, double-blind, placebo-controlled study to evaluate this hypothesis.
Methods: Forty-six patients with PD and mild-moderate depression randomly assigned to active (n = 23) and sham (n = 23) rTMS. Two patient in the sham group did not complete the protocol because of reasons unrelated to the study. High frequency rTMS was applied over the primary motor cortex bilaterally for 10 days. An investigator blinded to the treatment performed three video-taped examinations on each patient: before stimulation (baseline), 1 day (short term), and 30 days after treatment session ended (long-term effect). Primary endpoint was the changes in depression while secondary endpoints included health-related quality of life scales and Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS).
Results: In the actively-treated group not only the severity of depression (from 17 to 7 points, Montgomery–Asberg Depression Rating Scale, median values, p < 0.001) improved, but also the health-related quality of life (from 25.4 to 9.6 points, PDQ-39 summary index, median values, p < 0.001). Besides, we could also demonstrate an improvement in MDS-UPDRS Motor Examination. In the sham-treated group none of the examined tests and scales improved significantly after sham stimulation.
Conclusions: Our results demonstrate the beneficial effects of high frequency rTMS over the motor cortex on depression and health-related quality of life in PD. However, this result should be confirmed in patients with severe depression by further clinical trials.
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© 2015 Published by Elsevier Inc.
