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Transcranial Magnetic Stimulation of the Cerebellum in Essential Tremor
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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