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J Neurol Neurosurg Psychiatry. 2005 December; 76(12): 1614–1623.
PMCID: PMC1739437

Non-invasive brain stimulation for Parkinson's disease: a systematic review and meta-analysis of the literature


A systematic review and meta-analysis were conducted to quantify the efficacy of transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) for the treatment of motor dysfunction in patients with Parkinson's disease (PD). Prospective studies which evaluated the effects of either TMS (12 studies) or ECT (five studies) on motor function in PD using the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS) for TMS studies and any continuous measures of motor function in PD for ECT studies were included. The pooled effect size (standardised mean difference between pre-treatment versus post-treatment means) from a random effects model was 0.62 (95% confidence interval: 0.38, 0.85) for TMS treatment and 1.68 (0.79, 2.56) for ECT treatment, and from a fixed effects model was 0.59 (0.39, 0.78) for TMS treatment and 1.55 (1.07, 2.03) for ECT treatment. TMS, across applied stimulation sites and parameters, can exert a significant, albeit modest, positive effect on the motor function of patients with PD. ECT also may exert a significant effect on motor function in PD patients.

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Selected References

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  • Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson's disease (2001): treatment guidelines. Neurology. 2001 Jun;56(11 Suppl 5):S1–S88. [PubMed]
  • Boucai L, Cerquetti D, Merello M. Functional surgery for Parkinson's disease treatment: a structured analysis of a decade of published literature. Br J Neurosurg. 2004 Jun;18(3):213–222. [PubMed]
  • Mottaghy FM, Krause BJ, Kemna LJ, Töpper R, Tellmann L, Beu M, Pascual-Leone A, Müller-Gärtner HW. Modulation of the neuronal circuitry subserving working memory in healthy human subjects by repetitive transcranial magnetic stimulation. Neurosci Lett. 2000 Feb 25;280(3):167–170. [PubMed]
  • Paus T, Castro-Alamancos MA, Petrides M. Cortico-cortical connectivity of the human mid-dorsolateral frontal cortex and its modulation by repetitive transcranial magnetic stimulation. Eur J Neurosci. 2001 Oct;14(8):1405–1411. [PubMed]
  • Fall PA, Ekman R, Granérus AK, Thorell LH, Wålinder J. ECT in Parkinson's disease. Changes in motor symptoms, monoamine metabolites and neuropeptides. J Neural Transm Park Dis Dement Sect. 1995;10(2-3):129–140. [PubMed]
  • Andersen K, Balldin J, Gottfries CG, Granérus AK, Modigh K, Svennerholm L, Wallin A. A double-blind evaluation of electroconvulsive therapy in Parkinson's disease with "on-off" phenomena. Acta Neurol Scand. 1987 Sep;76(3):191–199. [PubMed]
  • Mally J, Stone TW. Therapeutic and "dose-dependent" effect of repetitive microelectroshock induced by transcranial magnetic stimulation in Parkinson's disease. J Neurosci Res. 1999 Sep 15;57(6):935–940. [PubMed]
  • de Groot M, Hermann W, Steffen J, Wagner A, Grahmann F. Kontralaterale und ipsilaterale repetitive transkranielle Magnetstimulation bei Parkinson-Patienten. Nervenarzt. 2001 Dec;72(12):932–938. [PubMed]
  • Lefaucheur Jean-Pascal, Drouot Xavier, Von Raison Florian, Ménard-Lefaucheur Isabelle, Cesaro Pierre, Nguyen Jean-Paul. Improvement of motor performance and modulation of cortical excitability by repetitive transcranial magnetic stimulation of the motor cortex in Parkinson's disease. Clin Neurophysiol. 2004 Nov;115(11):2530–2541. [PubMed]
  • Ikeguchi Michiko, Touge Tetsuo, Nishiyama Yoshihiro, Takeuchi Hiroaki, Kuriyama Shigeki, Ohkawa Motoomi. Effects of successive repetitive transcranial magnetic stimulation on motor performances and brain perfusion in idiopathic Parkinson's disease. J Neurol Sci. 2003 May 15;209(1-2):41–46. [PubMed]
  • Egger M, Smith GD, Phillips AN. Meta-analysis: principles and procedures. BMJ. 1997 Dec 6;315(7121):1533–1537. [PMC free article] [PubMed]
  • Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997 Sep 13;315(7109):629–634. [PMC free article] [PubMed]
  • Pascual-Leone A, Valls-Solé J, Brasil-Neto JP, Cohen LG, Hallett M. Akinesia in Parkinson's disease. I. Shortening of simple reaction time with focal, single-pulse transcranial magnetic stimulation. Neurology. 1994 May;44(5):884–891. [PubMed]
  • Pascual-Leone A, Valls-Solé J, Brasil-Neto JP, Cammarota A, Grafman J, Hallett M. Akinesia in Parkinson's disease. II. Effects of subthreshold repetitive transcranial motor cortex stimulation. Neurology. 1994 May;44(5):892–898. [PubMed]
  • Cunnington R, Iansek R, Thickbroom GW, Laing BA, Mastaglia FL, Bradshaw JL, Phillips JG. Effects of magnetic stimulation over supplementary motor area on movement in Parkinson's disease. Brain. 1996 Jun;119(Pt 3):815–822. [PubMed]
  • Ghabra MB, Hallett M, Wassermann EM. Simultaneous repetitive transcranial magnetic stimulation does not speed fine movement in PD. Neurology. 1999 Mar 10;52(4):768–770. [PubMed]
  • Valls-Solé J, Pascual-Leone A, Brasil-Neto JP, Cammarota A, McShane L, Hallett M. Abnormal facilitation of the response to transcranial magnetic stimulation in patients with Parkinson's disease. Neurology. 1994 Apr;44(4):735–741. [PubMed]
  • Siebner HR, Mentschel C, Auer C, Conrad B. Repetitive transcranial magnetic stimulation has a beneficial effect on bradykinesia in Parkinson's disease. Neuroreport. 1999 Feb 25;10(3):589–594. [PubMed]
  • Ellaway PH, Davey NJ, Maskill DW, Dick JP. The relation between bradykinesia and excitability of the motor cortex assessed using transcranial magnetic stimulation in normal and parkinsonian subjects. Electroencephalogr Clin Neurophysiol. 1995 Jun;97(3):169–178. [PubMed]
  • Börnke Ch, Schulte T, Przuntek H, Müller Th. Clinical effects of repetitive transcranial magnetic stimulation versus acute levodopa challenge in Parkinson's disease. J Neural Transm Suppl. 2004;(68):61–67. [PubMed]
  • Fall PA, Granérus AK. Maintenance ECT in Parkinson's disease. J Neural Transm. 1999;106(7-8):737–741. [PubMed]
  • Zervas IM, Fink M. ECT and delirium in Parkinson's disease. Am J Psychiatry. 1992 Dec;149(12):1758–1760. [PubMed]
  • Pridmore S, Lowrie A, Holmes G, Pollard C. ECT in Parkinson's disease: neuropsychological response. Convuls Ther. 1996 Dec;12(4):257–259. [PubMed]
  • Ward C, Stern GM, Pratt RT, McKenna P. Electroconvulsive therapy in Parkinsonian patients with the "on-off" syndrome. J Neural Transm. 1980;49(1-2):133–135. [PubMed]
  • Pridmore S, Pollard C. Electroconvulsive therapy in Parkinson's disease: 30 month follow up. J Neurol Neurosurg Psychiatry. 1996 Jun;60(6):693–693. [PMC free article] [PubMed]
  • Balldin J, Edén S, Granérus AK, Modigh K, Svanborg A, Wålinder J, Wallin L. Electroconvulsive therapy in Parkinson's syndrome with "on-off" phenomenon. J Neural Transm. 1980;47(1):11–21. [PubMed]
  • Fregni F, Santos CM, Myczkowski ML, Rigolino R, Gallucci-Neto J, Barbosa ER, Valente KD, Pascual-Leone A, Marcolin MA. Repetitive transcranial magnetic stimulation is as effective as fluoxetine in the treatment of depression in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2004 Aug;75(8):1171–1174. [PMC free article] [PubMed]
  • Okabe Shingo, Ugawa Yoshikazu, Kanazawa Ichiro. 0.2-Hz repetitive transcranial magnetic stimulation has no add-on effects as compared to a realistic sham stimulation in Parkinson's disease. Mov Disord. 2003 Apr;18(4):382–388. [PubMed]
  • Shimamoto H, Takasaki K, Shigemori M, Imaizumi T, Ayabe M, Shoji H. Therapeutic effect and mechanism of repetitive transcranial magnetic stimulation in Parkinson's disease. J Neurol. 2001 Sep;248 (Suppl 3):III48–III52. [PubMed]
  • Boylan LS, Pullman SL, Lisanby SH, Spicknall KE, Sackeim HA. Repetitive transcranial magnetic stimulation to SMA worsens complex movements in Parkinson's disease. Clin Neurophysiol. 2001 Feb;112(2):259–264. [PubMed]
  • Siebner HR, Rossmeier C, Mentschel C, Peinemann A, Conrad B. Short-term motor improvement after sub-threshold 5-Hz repetitive transcranial magnetic stimulation of the primary motor hand area in Parkinson's disease. J Neurol Sci. 2000 Sep 15;178(2):91–94. [PubMed]
  • Khedr EM, Farweez HM, Islam H. Therapeutic effect of repetitive transcranial magnetic stimulation on motor function in Parkinson's disease patients. Eur J Neurol. 2003 Sep;10(5):567–572. [PubMed]
  • Mally J, Stone TW. Improvement in Parkinsonian symptoms after repetitive transcranial magnetic stimulation. J Neurol Sci. 1999 Jan 15;162(2):179–184. [PubMed]
  • Tergau F, Wassermann EM, Paulus W, Ziemann U. Lack of clinical improvement in patients with Parkinson's disease after low and high frequency repetitive transcranial magnetic stimulation. Electroencephalogr Clin Neurophysiol Suppl. 1999;51:281–288. [PubMed]
  • Dragasevic Natasa, Potrebić Aleksandra, Damjanović Aleksandar, Stefanova Elka, Kostić Vladimir S. Therapeutic efficacy of bilateral prefrontal slow repetitive transcranial magnetic stimulation in depressed patients with Parkinson's disease: an open study. Mov Disord. 2002 May;17(3):528–532. [PubMed]
  • Balldin J, Granérus AK, Lindstedt G, Modigh K, Wålinder J. Predictors for improvement after electroconvulsive therapy in parkinsonian patients with on-off symptoms. J Neural Transm. 1981;52(3):199–211. [PubMed]
  • Douyon R, Serby M, Klutchko B, Rotrosen J. ECT and Parkinson's disease revisited: a "naturalistic" study. Am J Psychiatry. 1989 Nov;146(11):1451–1455. [PubMed]
  • Fall PA, Ekberg S, Granérus AK, Granérus G. ECT in Parkinson's disease-dopamine transporter visualised by [123I]-beta-CIT SPECT. J Neural Transm. 2000;107(8-9):997–1008. [PubMed]
  • Rumi Demetrio Ortega, Gattaz Wagner F, Rigonatti Sergio Paulo, Rosa Moacyr Alexandro, Fregni Felipe, Rosa Marina Odebrecht, Mansur Carlos, Myczkowski Martin Luiz, Moreno Ricardo Alberto, Marcolin Marco Antonio. Transcranial magnetic stimulation accelerates the antidepressant effect of amitriptyline in severe depression: a double-blind placebo-controlled study. Biol Psychiatry. 2005 Jan 15;57(2):162–166. [PubMed]
  • Lefaucheur Jean-Pascal. Motor cortex dysfunction revealed by cortical excitability studies in Parkinson's disease: influence of antiparkinsonian treatment and cortical stimulation. Clin Neurophysiol. 2005 Feb;116(2):244–253. [PubMed]
  • Morari M, Marti M, Sbrenna S, Fuxe K, Bianchi C, Beani L. Reciprocal dopamine-glutamate modulation of release in the basal ganglia. Neurochem Int. 1998 Nov;33(5):383–397. [PubMed]
  • Keck ME, Welt T, Müller MB, Erhardt A, Ohl F, Toschi N, Holsboer F, Sillaber I. Repetitive transcranial magnetic stimulation increases the release of dopamine in the mesolimbic and mesostriatal system. Neuropharmacology. 2002 Jul;43(1):101–109. [PubMed]
  • Strafella AP, Paus T, Barrett J, Dagher A. Repetitive transcranial magnetic stimulation of the human prefrontal cortex induces dopamine release in the caudate nucleus. J Neurosci. 2001 Aug 1;21(15):RC157–RC157. [PubMed]
  • Catalan MJ, Ishii K, Honda M, Samii A, Hallett M. A PET study of sequential finger movements of varying length in patients with Parkinson's disease. Brain. 1999 Mar;122(Pt 3):483–495. [PubMed]
  • Sabatini U, Boulanouar K, Fabre N, Martin F, Carel C, Colonnese C, Bozzao L, Berry I, Montastruc JL, Chollet F, et al. Cortical motor reorganization in akinetic patients with Parkinson's disease: a functional MRI study. Brain. 2000 Feb;123(Pt 2):394–403. [PubMed]
  • Lisanby SH, Belmaker RH. Animal models of the mechanisms of action of repetitive transcranial magnetic stimulation (RTMS): comparisons with electroconvulsive shock (ECS). Depress Anxiety. 2000;12(3):178–187. [PubMed]
  • Fochtmann L. A Mechanism for the Efficacy of ECT in Parkinson's Disease. Convuls Ther. 1988;4(4):321–327. [PubMed]
  • Kennedy Richard, Mittal Dinesh, O'Jile Judith. Electroconvulsive therapy in movement disorders: an update. J Neuropsychiatry Clin Neurosci. 2003 Fall;15(4):407–421. [PubMed]
  • Bolwig TG, Hertz MM, Holm-Jensen J. Blood-brain barrier during electroshock seizures in the rat. Eur J Clin Invest. 1977 Apr;7(2):95–100. [PubMed]
  • Naeser Margaret A, Martin Paula I, Nicholas Marjorie, Baker Errol H, Seekins Heidi, Kobayashi Masahito, Theoret Hugo, Fregni Felipe, Maria-Tormos Jose, Kurland Jacquie, et al. Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study. Brain Lang. 2005 Apr;93(1):95–105. [PubMed]
  • Dannon Pinhas N, Dolberg Ornah T, Schreiber Shaul, Grunhaus Leon. Three and six-month outcome following courses of either ECT or rTMS in a population of severely depressed individuals--preliminary report. Biol Psychiatry. 2002 Apr 15;51(8):687–690. [PubMed]
  • Li Xingbao, Nahas Ziad, Anderson Berry, Kozel F Andrew, George Mark S. Can left prefrontal rTMS be used as a maintenance treatment for bipolar depression? Depress Anxiety. 2004;20(2):98–100. [PubMed]
  • Málly J, Farkas R, Tóthfalusi L, Stone TW. Long-term follow-up study with repetitive transcranial magnetic stimulation (rTMS) in Parkinson's disease. Brain Res Bull. 2004 Sep 30;64(3):259–263. [PubMed]
  • Goetz Christopher G, Leurgans Sue, Raman Rema. Placebo-associated improvements in motor function: comparison of subjective and objective sections of the UPDRS in early Parkinson's disease. Mov Disord. 2002 Mar;17(2):283–288. [PubMed]
  • Wassermann EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalogr Clin Neurophysiol. 1998 Jan;108(1):1–16. [PubMed]
  • Nitsche MA, Paulus W. Sustained excitability elevations induced by transcranial DC motor cortex stimulation in humans. Neurology. 2001 Nov 27;57(10):1899–1901. [PubMed]
  • Canavero Sergio, Paolotti Riccardo, Bonicalzi Vincenzo, Castellano Giancarlo, Greco-Crasto Stefania, Rizzo Laura, Davini Ottavio, Zenga Francesco, Ragazzi Paola. Extradural motor cortex stimulation for advanced Parkinson disease. Report of two cases. J Neurosurg. 2002 Nov;97(5):1208–1211. [PubMed]
  • Drouot Xavier, Oshino Satoru, Jarraya Bechir, Besret Laurent, Kishima Haruhiko, Remy Philippe, Dauguet Julien, Lefaucheur Jean Pascal, Dollé Frédéric, Condé Françoise, et al. Functional recovery in a primate model of Parkinson's disease following motor cortex stimulation. Neuron. 2004 Dec 2;44(5):769–778. [PubMed]

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