Effect of cumulative repetitive transcranial magnetic stimulation on freezing of gait in patients with atypical Parkinsonism: A pilot study

To investigate the potential of cumulative high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) on freezing of gait in atypical Parkinsonism.Randomized, single-blinded, crossover study with a blinded observer.Eight patients with atypical Parkinsonism.All participants received HF-rTMS over the lower leg primary motor cortex (M1-LL) for 5 consecutive days. Alternative sham stimulation was also administered with a 2-week wash-out period. Freezing of Gait Questionnaire (FOG-Q), turn steps in the modified Standing Start 180° Turn Test, the Timed Up and Go (TUG) task, and the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) were performed before, after, and one week after rTMS.All participants completed this study without any significant adverse effects. FOG-Q and turn steps revealed significant improvements over time in the rTMS compared with the sham stimulation (χ2=6.067, p=0.048 and χ2=9.083, p=0.011). In addition, the TUG task and UPDRS-III showed significant improvements over time in the rTMS compared with the sham stimulation (χ2=7.200, p=0.02 and χ2=7.000, p=0.030).Cumulative HF-rTMS over the M1-LL might be effective for improving freezing of gait in patients with atypical Parkinsonism. Further investigation with a large number of participants is needed to clarify the effects of HF- rTMS on freezing of gait in atypical Parkinsonism.