Cervical Dystonia Treatment with Injections Supplemented by Transcranial Magnetic Stimulation: The D‐ TWIST Pilot Randomized Controlled Trial

BACKGROUND: For some patients with cervical dystonia (CD), botulinum toxin (BoNT) injections last less than 12 weeks. OBJECTIVES: To determine if a novel, accelerated repetitive transcranial magnetic stimulation (rTMS) protocol is a safe and feasible adjunctive treatment with BoNT for CD. METHODS: Patients with CD reporting BoNT benefit lasting ≤9 weeks were enrolled in a randomized double-blind, sham-controlled, crossover study. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), mood, cognitive, and gait measures were collected before, after, and 2-weeks following rTMS/SHAM. RESULTS: In a homogenous subset of patients (N = 4/5), TWSTRS scores were lower 2-weeks following rTMS, but evidence of an effect was potentially limited by sample size. There was little evidence of rTMS effects on mood, cognition, or gait. CONCLUSIONS: Accelerated rTMS for CD was safe, feasible, and well-tolerated; larger randomized studies are needed to determine whether accelerated rTMS may be an effective treatment bridge for dystonia symptoms.