Table 1.
rTMS studies for therapeutic purpose
| References | Patient group | Study design | Intervention | Target of the stimulation | Effect |
|---|---|---|---|---|---|
| Siebner et al. [16] | 16 WC patients and 11 HV | Open-label | Single session of 1 Hz rTMS at 10% below the RMT (1,800 biphasic stimuli) | Left M1 | Significantly reduced mean writing pressure, normalization of the deficient cortico-cortical inhibition, and prolongation of the cSP |
| Murase et al. [15] | 9 WC and 7 HV | Single-blinded | Single session of 0.2 Hz rTMS at 85% RMT (250 monophasic stimuli) vs. sham | M1, PMC, and SMA | Decreased tracking error and pen pressure with PMC stimulation, prolongation of cSP with PMC stimulation |
| Borich et al. [17] | 6 FHD (3 WC and 3 MD) and 9 HV | Single-blinded partial cross-over | 1 Hz rTMS at 90% RMT (900 monophasic stimuli) vs. sham for 5 days | PMC | Improved handwriting performance and reduced cortical excitability 10 days post treatment |
| Havrankova et al. [18] | 11 WC | Double-blinded cross-over | 1 Hz at 90% AMT (biphasic 1,800 stimuli) vs. sham-rTMS for 5 days | SI contralateral to affected hand | Subjective and objective improvement in writing 2 weeks post treatment associated with increased task-related BOLD in fMRI |
| Huang et al. [19] | 18 WC and 8 HV | Single-blinded randomized parallel | cTBS (3-pulse 50 Hz burst every 200 ms at 80% AMT for 40 sec) vs. sham daily for 5 days | Left PMC | More subjective improvement in writing with real rTMS Restoration of SICI, PMC-M1 interaction, and reduced M1 plasticity |
| Kimberley et al. [20] | 12 FHD | Single-blinded randomized with partial cross-over | 1 Hz rTMS with 90% RMT (biphasic 1,800 stimuli) vs. sham during non-dystonic writing movement for 5 days | Contralateral PMC | Prolonged cSP and reduced pen force |
| Kimberley et al. [21] | 9 FHD | Randomized with cross-over | 5 days 1 Hz rTMS at 80% RMT (biphasic 1,200 pulses) + sensorimotor retraining vs. rTMS + control therapy | PMC | No additional benefit from sensorimotor retraining |
rTMS: repetitive transcranial magnetic stimulation, WC: writer’s cramp, HV: healthy volunteer, RMT: resting motor threshold, cSP: cortical silent period, PMC: premotor cortex, SMA: supplementary motor area, FHD: focal hand dystonia, MD: musician’s dystonia, AMT: active motor threshold, BOLD: blood oxygenation level dependent, fMRI: functional magnetic resonance imaging, cTBS: continuous theta burst stimulation, SICI: short latency intracortical inhibition, M1: motor cortex.