Clinical and neurophysiological effects of bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson's disease: a randomized, four-arm controlled trial.

Romero, Juan Pablo;Moreno Verdu, Marcos;Arroyo-Ferrer, Aida;Serrano, J Ignacio;Del Castillo, María Dolores;et.al.
(2024) Journal of neuroengineering and rehabilitation — Vol. 21, n° 1, p. 135 [1-15] (2024)

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Authors
  • Romero, Juan Pablo
    Author
  • Moreno Verdu, MarcosUCLouvain
    Author
  • Arroyo-Ferrer, Aida
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  • Serrano, J Ignacio
    Author
  • Del Castillo, María Dolores
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Abstract
BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) and EEG-guided neurofeedback techniques can reduce motor symptoms in Parkinson's disease (PD). However, the effects of their combination are unknown. Our objective was to determine the immediate and short-term effects on motor and non-motor symptoms, and neurophysiological measures, of rTMS and EEG-guided neurofeedback, alone or combined, compared to no intervention, in people with PD. METHODS: A randomized, single-blinded controlled trial with 4 arms was conducted. Group A received eight bilateral, high-frequency (10 Hz) rTMS sessions over the Primary Motor Cortices; Group B received eight 30-minute EEG-guided neurofeedback sessions focused on reducing average bilateral alpha and beta bands; Group C received a combination of A and B; Group D did not receive any therapy. The primary outcome measure was the UPDRS-III at post-intervention and two weeks later. Secondary outcomes were functional mobility, limits of stability, depression, health-related quality-of-life and cortical silent periods. Treatment effects were obtained by longitudinal analysis of covariance mixed-effects models. RESULTS: Forty people with PD participated (27 males, age = 63 ± 8.26 years, baseline UPDRS-III = 15.63 ± 6.99 points, H&Y = 1-3). Group C showed the largest effect on motor symptoms, health-related quality-of-life and cortical silent periods, followed by Group A and Group B. Negligible differences between Groups A-C and Group D for functional mobility or limits of stability were found. CONCLUSIONS: The combination of rTMS and EEG-guided neurofeedback diminished overall motor symptoms and increased quality-of-life, but this was not reflected by changes in functional mobility, postural stability or depression levels. TRIAL REGISTRATION: NCT04017481.
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Romero, J. P., Moreno Verdu, M., Arroyo-Ferrer, A., Serrano, J. I., Herreros-Rodríguez, J., García-Caldentey, J., Rocon de Lima, E., & Del Castillo, M. D. (2024). Clinical and neurophysiological effects of bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson’s disease: a randomized, four-arm controlled trial. Journal of neuroengineering and rehabilitation, 21(1), 135 [1-15]. https://doi.org/10.1186/s12984-024-01427-5 (Original work published 2024)