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Randomized Controlled Trial
. 2024 Aug 5;21(1):135.
doi: 10.1186/s12984-024-01427-5.

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

Juan Pablo Romero  1   2   3 , Marcos Moreno-Verdú  4   5 , Aida Arroyo-Ferrer  1   2 , J Ignacio Serrano  6 , Jaime Herreros-Rodríguez  7 , Juan García-Caldentey  8 , Eduardo Rocon de Lima  6 , María Dolores Del Castillo  6
Affiliations
Randomized Controlled Trial

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

Juan Pablo Romero et al. J Neuroeng Rehabil. .

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.

Keywords: EEG; Motor symptoms; Neurofeedback; Non-invasive neuromodulation; Parkinson’s disease; Repetitive transcranial magnetic stimulation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Frames of the different Neurofeedback (NFB) environments designed for the intervention. Objects surrounded by the circles are the moving targets. Arrows indicated the direction and destination of the movement. Bottom right image: Experimental setup of participants, showing the Virtual Reality set up (Oculus® 3D), mounted over the 64-channel EEG cap
Fig. 2
Fig. 2
CONSORT flow diagram showing participant flow through each stage of the trial
Fig. 3
Fig. 3
Changes in the Unified Parkinson’s Disease Rating Scale-III (UPDRS-III) from baseline (T0) to post-intervention (T1) and follow-up (T2). Group A received bilateral, high-frequency Repetitive Transcranial Magnetic Stimulation (rTMS). Group B received EEG-guided neurofeedback (EEG-guided neurofeedback). Group C received a combination of rTMS and EEG-guided neurofeedback. Group D did not receive any intervention. Points represent means, thick lines represent standard errors and thin lines represent range
See this image and copyright information in PMC

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