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A Controlled Study

Alexandre Gironell, MD; Jaime Kulisevsky, MD; José Lorenzo, MD; Manel Barbanoj, MD; Berta Pascual-Sedano, MD; Pilar Otermin, MD

Arch Neurol. 2002;59:413-417.

Background  Growing evidence implicates an overactivity of the cerebellum in the pathophysiology of essential tremor. In a small series of patients, we explored the acute effects and therapeutic possibilities of low-frequency repetitive transcranial magnetic stimulation (rTMS) of the cerebellum in patients with essential tremor in a double-blind, crossover, placebo-controlled design.

Methods  Ten patients with essential tremor underwent an active and a sham rTMS session, at a 1-week interval. The rTMS was performed with a focal double 70-mm butterfly coil (maximum peak field of 2.2 T) applied 2 cm below the inion. Each session consisted of 30 trains of 10-second duration separated by 30-second pauses, at 100% of the maximum output intensity and at 1-Hz frequency. Major evaluation outcomes were the score on the Tremor Clinical Rating Scale and accelerometric recordings obtained before (-5 minutes), immediately after (+5 minutes), and 1 hour after (+60 minutes) each rTMS session. Both clinical and accelerometric measurements were obtained by a blinded neurologist.

Results  On the +5-minute assessment, active rTMS produced a notable tremor improvement compared with sham rTMS, as evidenced by a significant reduction in scores on the clinical rating scale and accelerometric values. At +60 minutes, no clinical or accelerometric benefit was evidenced. No adverse effects of rTMS were observed.

Conclusions  This exploratory study of the potential therapeutic properties of rTMS on essential tremor showed an acute antitremor effect. Further investigation in search of a more lasting benefit is warranted.

From the Movement Disorders Section, Department of Neurology (Drs Gironell, Kulisevsky, Pascual-Sedano, and Otermin), and Pharmacological Research Area (Drs Lorenzo and Barbanoj), Research Institute, Sant Pau Hospital, Autonomous University of Barcelona, Catalonia, Spain.

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