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Prof. Dr. Cengiz BAHADIR

Parkinson’s Disease

Transcranial Magnetic Stimulation in Parkinson’s Disease

Parkinson’s disease is a chronic degenerative central nervous system disease. It usually occurs at the age of >50 years. It can be seen in various forms. While it can be primary (idiopathic) and it can also be secondary. The reason for the symptoms of Parkinson’s disease is the degeneration and death of the cells in the part of the brain called basal ganglion, producing dopamine, for an unknown reason. Dopamine deficiency in the brain is manifested in many clinical symptoms. Tremor on the hands, slow movements, posture curvature, muscle stiffness and rigidity, difficulty in walking and walking by small steps are among the most common symptoms. It progresses very slowly and chronically and in later years, it may cause thought and behavioral problems, and in more advanced stages it may cause dementia. Sleep disorders are common. Depression is the most common psychiatric problem for Parkinson’s patients and it may be very resistant to therapy.

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Since there is a wide range of symptoms for this disease, there is no single treatment method for recovering all symptoms simultaneously. Drugs are very significant for the treatment of Parkinson’s disease. Dopamine and drugs with effects similar to dopamine are used. Single medication or combinations may be used. As these patients develop muscle weakness and difficulty in walking, rehabilitation is very important. The drugs administered for the treatment of Parkinson’s disease do not provide a direct benefit to the muscles and joints. It must be ensured that these patients are provided with rehabilitation to recover short muscles, stiffness, joint stiffness and difficulty in walking. Nonetheless, patients suffering from Parkinson’s disease are rarely provided with rehabilitation. Recently, positive outcomes have been observed for some symptoms of Parkinson’s disease thanks to electronic devices implanted with certain surgical interventions.
Transcranial magnetic stimulation (TMS) has been recently experimented for Parkinson’s disease. TMS treatment is based on the pain-free external stimulation of brain cells with magnetic field. The brain cells on the desired regions of the brain can be stimulated or suppressed based on the frequency of the magnetic field applied. This is carried out via a magnetic coil. There are nearly zero side effects of this method and applications within safety limits showed no serious side effects.

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TMS treatment has provided recovery in some symptoms of Parkinson’s disease. It has been detected that various TMS protocols administered for Parkinson’s disease resulted in significant improvement on depression, dystonia secondary to L-dopa medication, akinesia (loss of automatic movements), writing, and freezing during walking. The studies showing improvement on the motor symptoms upon the administration of high frequency TMS treatment into the cortical motor cortex for feet have been published. It has also been recorded in studies conducted with Parkinson’s disease that TMS treatment provided benefit on speech disorders.
As Parkinson’s disease is composed of a group of symptoms, it is not possible to provide treatment for all symptoms at once with TMS protocol. Nonetheless, there have been positive outcomes on individual symptoms. Although TMS treatment has been established as a standard for Parkinson’s disease, it is projected that it will be used as a routine therapy method for the symptoms of this disease.