J Clin Neurol.  2024 Jul;20(4):378-384. 10.3988/jcn.2023.0348.

Efficacy of Cerebellar Transcranial Magnetic Stimulation in Treating Essential Tremor: A Randomized, Sham-Controlled Trial

• El-Adawy AFI
• Reda MABMG
• Ahmed AM
• Rashad MH
• Zaki MA
• Mohamed MeT
• Hassan MAS
• Abdulsalam MF
• Hassan AM
• Mohamed AF
• Fayed AGI
• Meshref M
• Mansour FM
• Sarhan AE
• Elsheshiny AH
• Abed E

• KMID: 2556898
• DOI: http://doi.org/10.3988/jcn.2023.0348

Abstract

Background and Purpose
Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration.
Methods
A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM).
Results
Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively). However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001).
Conclusions
Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

Keyword

transcranial magnetic stimulation; cerebellum; essential tremors; randomized controlled trial