Addressing levodopa-unresponsive freezing of gait (FOG) in Parkinson’s disease (PD) presents a significant challenge. A randomized double-blinded trial evaluated the effects of repetitive transcranial magnetic stimulation (rTMS) in conjunction with transcutaneous magnetic spinal cord stimulation among 57 PD individuals experiencing levodopa-unresponsive FOG. Patients were randomized to receive dual-site stimulation involving bilateral primary motor cortex of the lower leg (M1-LL) and the lumbar spinal cord, single-site stimulation targeting bilateral M1-LL alone, or sham stimulation for 10 sessions. Low-frequency rTMS induced remarkable improvements in FOG, gait, and motor functions compared to sham at 1 day and 1 month postintervention. Notably, the dual-site protocol demonstrated superior efficacy in mitigating FOG and improving gait compared to the single-site approach, which correlated with a pronounced increase in short-interval intracortical inhibition of the abductor pollicis brevis. These findings underscore the potential of the cerebrospinal dual-site regimen as a promising approach for levodopa-unresponsive FOG and gait in PD.

解决帕金森病 (PD) 中左旋多巴无反应的步态冻结 (FOG) 是一项重大挑战。一项随机双盲试验评估了 57 名经历左旋多巴无反应 FOG 的 PD 患者中重复经颅磁刺激 (rTMS) 与经皮脊髓磁刺激的效果。患者被随机分配接受涉及小腿双侧初级运动皮层 (M1-LL) 和腰脊髓的双位点刺激、仅针对双侧 M1-LL 的单位点刺激或 10 次假刺激。与假手术相比，低频 rTMS 在干预后 1 天和 1 个月引起了 FOG、步态和运动功能的显着改善。值得注意的是，与单部位方法相比，双部位方案在减轻 FOG 和改善步态方面表现出卓越的功效，这与拇短展肌的短间隔皮质内抑制的显着增加相关。这些发现强调了脑脊液双位点治疗方案作为治疗帕金森病中左旋多巴无反应 FOG 和步态的一种有前途的方法的潜力。