Effect of Dual-Mode and Dual-Site Noninvasive Brain Stimulation on Freezing of Gait in Patients With Parkinson Disease

Objective To investigate the effect of dual-mode noninvasive brain stimulation (NIBS) with high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex of the lower leg and anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex compared with rTMS alone in patients with Parkinson disease (PD) with freezing of gait (FOG). Design Randomized, double-blind, controlled study. Setting Outpatient rehabilitation clinics. Participants Patients diagnosed as having PD with FOG (N=32). Interventions Patients in the dual-mode group underwent 5 consecutive daily sessions of dual-mode NIBS with high-frequency rTMS and tDCS simultaneously, whereas patients in the rTMS group underwent high-frequency rTMS and sham tDCS. Main Outcome Measures Assessments of FOG and motor, ambulatory, and cognitive function were performed 3 times: at baseline before NIBS, immediately after NIBS, and 1 week after cessation of NIBS. Results Serious adverse effects were not observed in either group. Significant changes over time were observed in FOG, motor function, and ambulatory function in each group; however, there was no significant difference between the 2 groups. Executive function showed significant improvement after NIBS only in the dual-mode group. Conclusions These results suggest the potential for dual-mode NIBS to modulate 2 different cortices simultaneously. Dual-mode NIBS might be considered a novel therapeutic approach for patients with PD.