|
Transcranial
Magnetic Stimulation in Parkinson's Disease
Principal
Investigator
Dr. Charles M. Epstein,
M.D. - Dr. Epstein performs transcranial magnetic stimulation (TMS)
and associated motor evoked potentials, supervises the recording of simultaneous
electroencephalograms (EEG) and electrocardiograms (EKG), monitors the
operation and safety of the magnetic stimulation equipment, and participates
in regular Center research conferences and progress assessments. Dr. Epstein
is a neurologist/clinical neurophysiologist with extensive experience
in electroencephalography and TMS. He has custom-built multiple magnetic
stimulators and coils, co-designing the first high-efficiency iron-core
coils, and has introduced the first non-invasive method for localizing
the site of magnetic stimulation in the human brain. He has established
at Emory University a major research focus in transcranial magnetic treatment
of depression.
Co-Principal
Investigator
Mahlon R. DeLong, M.D.
- Dr. DeLong reviews patients' records for optimum diagnosis and treatment
of Parkinson's Disease (PD) and performs the clinician portion of the
Movement Assessment Battery. He is a neurologist/neurophysiologist who
has extensive experience with combined behavioral/neurophysiologic studies
in behaving primates and in clinical movement disorders. Dr. DeLong is
the Chairman of the Department of Neurology at Emory University, where
he has established a major research focus devoted to studies on the functional
organization of the primate basal ganglia and their role in movement and
movement disorders. He has been a leader in the field of movement disorders
and has developed and tested pathophysiologic models for hypo- and hyper-kinetic
movement disorders, which have been the basis for much of the resurgence
of stereotaxic surgery for these disorders. He leads regular Center research
conferences and progress assessments.
Background
Depression complicates PD in up to 50% of cases, leading to further deterioration
of motor performance and quality of life. Additionally, antidepressant
medication fails or produces intolerable side effects in 25-30% of patients.
Case reports and uncontrolled trials suggest that ECT is effective in
ameliorating simultaneously the mood and motor symptoms of PD. Only a
few small studies of Electroconvulsive Therapy (ECT) in PD have been prospective
or randomized, the assessment protocols have been limited, and the results
have been variable. TMS is a new, promising, alternative treatment for
refractory depression, which appears to be easier and safer than ECT.
Requiring no hospitalization, anesthesia, or recovery time, TMS is now
being investigated as an alternative therapy for mood disorders. TMS has
not been studied in depressed patients with PD or in other serious central
nervous system diseases.
Study
The major aim of this study is to carry out a sequential Phase I trial
of prefrontal TMS. We are comprehensively evaluating the effects of left
prefrontal TMS on mood, motor, and neuropsychological function together
with quality of life indices in depressed PD patients. All patients will
initially receive treatment with TMS. Those who fail to benefit will proceed
to ECT. Comprehensive evaluation will be continued for another eight weeks
in both the TMS-only and ECT groups. The key issues being addressed are
1) the potential benefit of TMS on mood and movement in depressed PD patients,
and 2) the tightness of the association between mood and motor function
after TMS and ECT.
|
|
