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Parkinsonism Relat Disord. 2019 Mar 24. pii: S1353-8020(19)30179-8. doi: 10.1016/j.parkreldis.2019.03.019. [Epub ahead of print]

Cerebellar repetitive transcranial magnetic stimulation for patients with essential tremor.

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Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea; Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA. Electronic address:
Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA.
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.



The possibility of repetitive transcranial magnetic stimulation (rTMS) as an alternative therapy for essential tremor (ET) patients has emerged. However, its effect on medicated ET patients is lacking. The aim of this pilot study was to investigate the effect of cerebellar low-frequency rTMS as an "add-on" treatment.


In this single-blinded, randomized, sham-controlled pilot study, patients with ET were randomized into two groups, one receiving real-rTMS and the other sham-rTMS. For 5 days, 1200 stimulations per day were applied to the bilateral cerebellar hemispheres at an intensity of 90% of the resting motor threshold (RMT) with a frequency of 1-Hz. Motor evoked potentials (MEPs) and the Fahn-Tolosa-Marin tremor rating scales (TRS) were measured before, immediately, and 4 weeks after the completion of the rTMS procedures. All patients continued taking medications during all procedures.


Among 22 patients, 12 and 10 patients were randomized into the real- and sham-rTMS groups, respectively. Repeated analysis of variance (ANOVA) measurements showed that the total TRS, TRS-A and B were changed both in real and sham-rTMS groups without interaction between time and group. TRS-C and MEPs, were not significantly changed at each follow-up point in either the real or sham-rTMS sessions.


We conclude that cerebellar low-frequency rTMS is safe, but has no significant effect as an "add-on" therapy in patients with ET.


Cerebellum; Essential tremor; Repetitive transcranial magnetic stimulation

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