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El-Adawy AFI, Reda MABMG, Ahmed AM, Rashad MH, Zaki MA, Mohamed MET, Hassan MAS, Abdulsalam MF, Hassan AM, Mohamed AF, Fayed AGI, Meshref M, Mansour FM, Sarhan AE, Elsheshiny AH, Abed E. Efficacy of Cerebellar Transcranial Magnetic Stimulation in Treating Essential Tremor: A Randomized, Sham-Controlled Trial. J Clin Neurol 2024; 20:378-384. [PMID: 38951972 PMCID: PMC11220355 DOI: 10.3988/jcn.2023.0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND AND PURPOSE Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. METHODS A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). RESULTS Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively). However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). CONCLUSIONS Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.
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Affiliation(s)
| | | | - Ali Mahmoud Ahmed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Neurology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.
| | | | - Mohamed Ahmed Zaki
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | | | - Abdelmonem M Hassan
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Fathy Mohamed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ahmed E Sarhan
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Elsayed Abed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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El-Adawy AFI, Reda MABMG, Ahmed AM, Rashad MH, Zaki MA, Mohamed MET, Hassan MAS, Abdulsalam MF, Hassan AM, Mohamed AF, Fayed AGI, Meshref M, Mansour FM, Sarhan AE, Elsheshiny AH, Abed E. Efficacy of Cerebellar Transcranial Magnetic Stimulation in Treating Essential Tremor: A Randomized, Sham-Controlled Trial. J Clin Neurol 2024; 20. [DOI: https:/doi.org/10.3988/jcn.2023.0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 05/31/2024] Open
Affiliation(s)
| | | | - Ali Mahmoud Ahmed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Department of Neurology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | | | - Mohamed Ahmed Zaki
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | | | | | - Abdelmonem M Hassan
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Fathy Mohamed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ahmed E. Sarhan
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Elsayed Abed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Hale EA, Hickman R, Dowd H, Varathan D, Liu G, Louis ED. Subtle Cerebellar Features in Relatives of Essential Tremor Cases. Front Neurol 2020; 11:605. [PMID: 32765392 PMCID: PMC7379149 DOI: 10.3389/fneur.2020.00605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Essential tremor (ET) cases often exhibit a range of mild cerebellar signs. Their unaffected relatives have been shown in prior studies to exhibit subtle (i.e., preclinical) disease features. Objective: To quantify subtle cerebellar signs in unaffected first-degree relatives of ET cases stratified based on their tremor severity. Methods: Two hundred sixty-nine first-degree relatives of ET cases, none of whom reported tremor or a diagnosis of ET, or were diagnosed with ET based on detailed neurological examination, were stratified based on total tremor score (TTS) into two groups (lower TTS vs. higher TTS) and quartiles. Changes in gait, balance, and intention tremor were quantified on neurological examination. Results: Higher TTS performed worse on the tandem stance task (p = 0.011). When stratified into TTS quartiles, higher quartile was associated with worse performance in tandem stance (p = 0.011) and stance with feet together (p = 0.028). Similarly, intention tremor in the arms (p = 0.0002) and legs (p = 0.047) were higher in the groups with more tremor. Discussion: The links between ET and the cerebellum are multiple. These data provide intriguing evidence that subtle cerebellar signs (i.e., changes in balance and intention tremor) are more prevalent among first-degree relatives of ET cases with more tremor (i.e., those who may be themselves on the pathway to developing ET). These data contribute to a better characterization of what may be an early subclinical stage of the disease.
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Affiliation(s)
- Evan A Hale
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Ruby Hickman
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Hollie Dowd
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Deepti Varathan
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Gina Liu
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Elan D Louis
- Division of Movement Disorders, Department of Neurology, Yale School of Medicine, Yale University, New Haven, CT, United States.,Center for Neuroepidemiology and Clinical Neurological Research, Yale School of Medicine, Yale University, New Haven, CT, United States.,Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, United States
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Olfati N, Shoeibi A, Abdollahian E, Ahmadi H, Hoseini A, Akhlaghi S, Vakili V, Foroughipour M, Rezaeitalab F, Farzadfard MT, Layegh P, Naseri S. Cerebellar repetitive transcranial magnetic stimulation (rTMS) for essential tremor: A double-blind, sham-controlled, crossover, add-on clinical trial. Brain Stimul 2019; 13:190-196. [PMID: 31624048 DOI: 10.1016/j.brs.2019.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/28/2019] [Accepted: 10/03/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is controversial evidence about the effect of cerebellar low-frequency stimulation in patients with essential tremor (ET). OBJECTIVES In this study we assessed safety and effectiveness of 1 Hz (low-frequency) cerebellar repetitive transcranial magnetic stimulation (rTMS) on tremor severity in patients with essential tremor in a sham-controlled crossover trial. METHODS A total of 23 patients assigned into two groups to receive either sham (n = 10) or rTMS (n = 13) treatment, with crossing over after a two-month washout period. Intervention consisted of 900 pulses of 1 Hz rTMS at 90% resting motor threshold or the same protocol of sham stimulation over each cerebellar hemisphere for 5 consecutive days. Tremor severity was assessed by Fahn-Tolosa-Marin (FTM) scale at baseline and at days 5, 12 and 30 after intervention. The FTM consists of 3 subscales including tremor severity rating, performance of motor tasks, and functional disability. Carry-over and treatment effects were analyzed using independent samples t-test. RESULTS There was no significant improvement in the total FTM scores in rTMS compared to the sham stimulation on day 5 (p = 0.132), day 12 (p = 0.574), or day 30 (p = 0.382). Similarly, FTM subscales, including tremor severity rating, motor tasks, and functional disability did not improve significantly after rTMS treatment. Mild headache and local pain were the most frequent adverse events. CONCLUSION Although cerebellar rTMS seems to have acceptable safety when used in ET patients, this study could not prove any efficacy for it in reduction of tremor in these patients. Larger studies are needed to evaluate efficacy of this therapeutic intervention and to provide evidence about the optimal stimulation parameters.
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Affiliation(s)
- Nahid Olfati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Quaem Medical Center, Mashhad, Iran.
| | - Ali Shoeibi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Quaem Medical Center, Mashhad, Iran.
| | - Ebrahim Abdollahian
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Psychiatry and Behavioral Sciences Research Center, Ibn-Sina Medical Center, Mashhad, Iran.
| | - Hamideh Ahmadi
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Quaem Medical Center, Mashhad, Iran.
| | - Alireza Hoseini
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Saeed Akhlaghi
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Psychiatry and Behavioral Sciences Research Center, Ibn-Sina Medical Center, Mashhad, Iran.
| | - Vida Vakili
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohsen Foroughipour
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Quaem Medical Center, Mashhad, Iran.
| | - Fariborz Rezaeitalab
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Quaem Medical Center, Mashhad, Iran.
| | - Mohammad-Taghi Farzadfard
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Quaem Medical Center, Mashhad, Iran.
| | - Parvaneh Layegh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Quaem Medical Center, Mashhad, Iran.
| | - Shahrokh Naseri
- Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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