Marked improvement of postural and gait disturbances in Parkinson’s disease with bilateral primary motor area intermittent theta-burst stimulation may be linked to increased putamen-cortico-cerebellar functional connectivity: a case report
- Rashid-López, Raúl
- Cruz-Gómez, Álvaro J.
- Macías-García, Paloma
- Sánchez-Fernández, F. Luis
- Lozano-Soto, Elena
- Sanmartino, Florencia
- Cano-Cano, Fátima
- Rubio-Esteban, Guillermo
- Espinosa-Rosso, Raúl
- González-Rosa, Javier J.
ISSN: 1935-861X
Año de publicación: 2023
Volumen: 16
Número: 1
Páginas: 271-272
Tipo: Artículo
Otras publicaciones en: Brain Stimulation
Resumen
Background: Postural impairments and gait disturbances is a clinical feature of Parkinson's disease (PD) and a primary contribution to decreasing mobility and quality of life that often become less responsive to pharmacological or neurosurgical treatment. Recent evidence suggests that intermittent theta burst stimulation (iTBS) might be a more efficient form of noninvasive neuromodulation therapy with long-lasting motor effects in PD, but the potential brain structural and functional significance of these changes remain unclear. Methods: We present the case of a right-handed, 66-year-old man with PD, receiving long-term treatment with levodopa and with patent symptoms of bradykinesia, altered stability, and gait disturbances that was recruited in a double-blind, randomized, sham-controlled pilot study of iTBS over bilateral primary motor cortex (M1) as part of his clinical treatment. The patient On medication underwent 5 sessions of iTBS (1wk), a washout period (12wk), and then 5 sessions of sham stimulation (1wk). Motor evaluation was used at different follow-ups, and neurocognitive assessment, M1 excitability, and a combined structural and resting-state functional MRI testing were performed initially and after the end (1wk) of therapeutic course. MRI data were compared relative to 17 PD control patients. Results: Compared to baseline and sham stimulation, iTBS produced a manifest improvement of postural and gait disturbances and a reduction of upper/lower limbs bradykinesia that lasted up to 1 month after treatment. Interestingly, iTBS resulted both in increased putamen-parietal-cerebellar and supplementary motor area-prefrontal functional connectivity, as well as in a decreased left caudate volume. All these changes turned to baseline values during pre- and post-sham evaluations. Conclusions: The present case demonstrates that PD axial symptoms may be successfully treated with short series of bilateral M1 iTBS and that increased putamen-cerebellar and prefrontal functional connectivity may reflect a compensatory mechanism underlying improvement of transient postural and gait disturbances in PD.