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Neurology 1999;52:529
© 1999 American Academy of Neurology


Articles

Low-frequency repetitive transcranial magnetic stimulation of the motor cortex in writer’s cramp

H. R. Siebner, MD, J. M. Tormos, MD, A. O. Ceballos- Baumann, MD, C. Auer, MD, M. D. Catala, MD, B. Conrad, MD and A. Pascual-Leone, MD, PhD

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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