Neuronavigated repetitive transcranial magnetic stimulation improves depression, anxiety and motor symptoms in Parkinson’s disease

Background Repetitive transcranial magnetic stimulation (rTMS) is a potential treatment option for Parkinson's disease patients with depression (DPD), but conflicting results in previous studies have questioned its efficacy. Method To investigate the safety and efficacy of neuronavigated high-frequency rTMS at the left DLPFC in DPD patients, we conducted a randomized, double-blind, sham-controlled study (NCT04707378). Sixty patients were randomly assigned to either a sham or active stimulation group and received rTMS for ten consecutive days. The primary outcome was HAMD, while secondary outcomes included HAMA, MMSE, MoCA and MDS-UPDRS-III. Assessments were performed at baseline, immediately after treatment, 2 weeks, and 4 weeks post-treatment. Results The GEE analysis showed that the active stimulation group had significant improvements in depression, anxiety, and motor symptoms at various time points. Specifically, there were significant time-by-group interaction effects in depression immediately after treatment (β, −4.34 [95% CI, −6.90 to −1.74; P = 0.001]), at 2 weeks post-treatment (β, −3.66 [95% CI, −6.43 to −0.90; P = 0.010]), and at 4 weeks post-treatment (β, −4.94 [95% CI, −7.60 to −2.29; P < 0.001]). Similarly, there were significant time-by-group interaction effects in anxiety at 4 weeks post-treatment (β, −2.65 [95% CI, −4.96 to −0.34; P = 0.024]) and in motor symptoms immediately after treatment (β, −5.72 [95% CI, −9.10 to −2.34; P = 0.001] and at 4 weeks post-treatment (β, −5.43 [95% CI, −10.24 to −0.61; P = 0.027]). Conclusion The study suggested that neuronavigated high-frequency rTMS at left DLPFC is effective for depression, anxiety, and motor symptoms in PD patients.