Effect of high frequency repetitive transcranial magnetic stimulation on reaction time, clinical features and cognitive functions in patients with Parkinson's disease.

The aim of the present study was to investigate the effects of one session of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied over the left dorsal premotor cortex (PMd) and left dorsolateral prefrontal cortex (DLPFC) on choice reaction time in a noise-compatibility task, and cognitive functions in patients with Parkinson's disease (PD). Clinical motor symptoms of PD were assessed as well. Ten patients with PD entered a randomized, placebo-controlled study with a crossover design. Each patient received 10 Hz stimulation over the left PMd and DLPFC (active stimulation sites) and the occipital cortex (OCC; a control stimulation site) in the OFF motor state, i.e. at least after 12 h of dopaminergic drugs withdrawal. Frameless stereotaxy was used to target the optimal position of the coil. For the evaluation of reaction time, we used a noise-compatibility paradigm. A short battery of neuropsychological tests was performed to evaluate executive functions, working memory, and psychomotor speed. Clinical assessment included a clinical motor evaluation using part III of the Unified Parkinson's Disease Rating Scale. Statistical analysis revealed no significant effect of rTMS applied over the left PMd and/or DLPFC in patients with PD in any of the measured parameters. In this study, we did not observe any effect of one session of high frequency rTMS applied over the left PMd and/or DLPFC on choice reaction time in a noise-compatibility task, cognitive functions, or motor features in patients with PD. rTMS applied over all three stimulated areas was well tolerated and safe in terms of the cognitive and motor effects.

Effects of ropinirole on nonmotor symptoms of Parkinson disease: a prospective multicenter study.

OBJECTIVE: To evaluate the effects of ropinirole on selected nonmotor symptoms of Parkinson's disease (PD), including anxiety, depressive symptoms, sleep disturbances/excessive daytime sleepiness, and sexual functions. METHODS: Forty-four consecutive PD patients with or without motor complications (MC+ group and MC- group, respectively); 6-month prospective study; scales administered in the "on" motor state: Unified Parkinson's Disease Rating Scale, Hamilton Anxiety Scale (HAMA), Montgomery-Asberg Depression Rating Scale (MADRS), Parkinson's Disease Sleep Scale, Epworth Sleep Scale, International Index of Erectile Function, and Female Sexual Function Index; serum sexual hormones collected. RESULTS: The median ropinirole dose was 10 mg, and the median L-dopa dose was decreased in both groups. In addition to motor symptoms and motor complications improvement, both median HAMA and MADRS scores dropped significantly in MC+ group; patients in our MC- group had little or no anxiety and depression at the baseline visit. In men, the baseline anxiety score was negatively correlated with the serum testosterone level. We did not observe any changes in the scales assessing sleep and sexual functions. Changes in Unified Parkinson's Disease Rating Scale III scores significantly correlated with ropinirole dosage. Changes in HAMA and MADRS correlated only with changes in Parkinson's Disease Sleep Scale scores. CONCLUSION: In addition to controlling motor symptoms, ropinirole improved both anxiety and depressive symptoms in PD patients with motor fluctuations and/or dyskinesias. Changes in mood and anxiety correlated with changes in sleep scores.