Effects of DBS, premotor rTMS, and levodopa on motor function and silent period in advanced Parkinson's disease

Tobias Bäumer*, Ute Hidding, Wolfgang Hamel, Carsten Buhmann, Christian K.E. Moll, Christian Gerloff, Michael Orth, Hartwig Roman Siebner, Alexander Münchau

*Corresponding author for this work
27 Citations (Scopus)


Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a widely used and highly effective treatment for patient(rTMS) applied to motor cortical areas has also been shown to improve symptoms in PD and modulate motor cortical excitability. Here, we compared clinical and neurophysiological effects of STN stimulation with those of 1 Hz rTMS given to the dorsal premotor cortex (PMd) and those following intake of levodopa in a group of PD patients with advanced disease. Ten PD patients were studied on 2 consecutive days before and after surgery. Clinical effects were determined using the UPDRS motor score. Motor thresholds, motor-evoked potential (MEP) amplitudes during slight voluntary contraction, and the cortical silent periods (SP) were measured using TMS. Before surgery effects of levodopa and 1 Hz PMd rTMS and after surgery those of STN stimulation with or without additional levodopa were determined. Levodopa significantly improved clinical symptoms and increased the SP duration. STN stimulation improved clinical symptoms without changing the SP duration. In contrast, 1 Hz PMd rTMS was not effective clinically but normalized the SP duration. Whereas levodopa had widespread effects at different levels of an abnormally active motor network in PD, STN stimulation and PMd rTMS led to either clinical improvement or SP normalization, i.e., only partially reversed abnormal motor network activity.

Original languageEnglish
JournalMovement Disorders
Issue number5
Pages (from-to)672-676
Number of pages5
Publication statusPublished - 15.04.2009


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