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From the Department of Neurology (Drs. Siebner, Ceballos-Baumann, Auer, and Conrad), Technical University of Munich, Germany; Unidad de Neurobiologia, Department of Physiology (Drs. Tormos, Catala, and Pascual-Leone), University of Valencia, and Instituto Cajal, Consejo Superior de Investigaciones Cientificas, Valencia, Spain; and Laboratory for Magnetic Brain Stimulation (Dr. Pascual-Leone), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Address correspondence and reprint requests to Dr. Hartwig Roman Siebner, Department of Neurology, Technical University of Munich, Moehlstrasse 28, D-81675 Munich, Germany.
OBJECTIVE: To study the short-term effects of slow repetitive transcranial magnetic stimulation (rTMS) of the motor cortex on cortical excitability and handwriting in patients with writer’s cramp.
BACKGROUND: Cortical excitability of the primary motor cortex is abnormally enhanced in patients with writer’s cramp. Therefore, reducing cortical excitability by low-frequency rTMS of the motor cortex might result in beneficial effects on handwriting in writer’s cramp.
DESIGN/METHODS: We studied the effects of subthreshold 1-Hz rTMS on motor threshold and cortico-cortical excitability using the paired-pulse technique in seven patients and seven controls. In another 16 patients and 11 age-matched controls we evaluated changes in cortical excitability by measuring the stimulus-response curve and the postexcitatory silent period before and after subthreshold 1-Hz rTMS. In addition, we analyzed the handwriting before and 20 minutes after 1-Hz rTMS.
RESULTS: In the first experiment, low-frequency rTMS resulted in a normalization of the deficient cortico-cortical inhibition in the patients without affecting motor threshold. In the second experiment, 1-Hz rTMS resulted in a significant prolongation of the postexcitatory silent period without affecting the stimulus-response curve in the patient group. Moreover, the dystonic patients showed a significant reduction of mean writing pressure after subthreshold 1-Hz rTMS that was associated with clear but transient improvement in six patients.
CONCLUSIONS: In some patients 1-Hz rTMS can reinforce deficient intracortical inhibition and may improve handwriting temporarily. Our data support the notion that reduced intracortical inhibition plays a part in the pathophysiology of focal dystonia.
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