The Efficacy and Safety of Precision REpetitive Transcranial Magnetic Stimulation in Alleviating Motor Symptom in Parkinson's Disease

A Randomized, Double-blind, Multicenter, Placebo-controlled Trial (PRESS-PD)

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and widely used neuromodulation technology. Small sample studies have shown that rTMS treatment can significantly improve the symptoms of Parkinson's disease(PD) and delay the progression of the disease. In order to further explore the effectiveness of rTMS in the treatment of PD and lay the foundation for its clinical promotion, our research team plans to conduct a randomized double-blind controlled study of rTMS in the treatment of PD in multiple centers across the country.

Study Overview

• Status: Recruiting
• Conditions: Parkinson Disease; Transcranial Magenetic Stimualtion; Supplementary Motor Area
• Intervention / Treatment: Other: transcranial magnetic stimulation

Detailed Description

This is a multi-center, double-blind, randomized controlled study that will be implemented in multiple hospital centers in China. In this study, the supplementary motor area (SMA) of the dominant hemisphere was selected as the stimulation target, and continuous theta burst stimulation (cTBS) sequence contact stimulation was used for a course of continuous stimulation for 7 days to observe the changes in clinical symptoms before and after the intervention.

• Study Type: Interventional
• Enrollment (Estimated): 290
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Panpan Hu, M.D.; Phone Number: +8613515602285; Email: hpppanda9@126.com
• Study Contact Backup: Name: Kai Wang, Ph.D.; Phone Number: +8655162923704; Email: Wangkai1964@126.com

Study Locations

• China
  • Anhui
    • Hefei, Anhui, China, 230032
      • Recruiting
      • Cognitive Neuropsychology Lab Anhui Medical University
      • Contact: panpan hu, M.D.; Phone Number: +8655162923704; Email: hpppanda9@126.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age ≥ 40 years old;
2. Meet the diagnostic criteria for idiopathic Parkinson's disease (MDS Diagnostic Criteria for Parkinson's Disease (2015 Edition))[1];
3. Have no history of drug adjustment within 4 weeks before treatment and the entire study period;
4. The MDS-UPDRS Ⅲ score ≥8, and the Hoehn-Yahr rating is 1-4;
5. MMSE ≥22，able to cooperate with the completion of behavioral tests and transcranial magnetic stimulation therapy.

Exclusion Criteria:

1. Previously head MRI/CT was focal brain injury or severe leukoencephalopathy (Fazekas grade 3 and above);
2. Various secondary parkinsonism syndromes (vascular parkinsonism, Parkinsonism combined with parkinsonism, drug parkinsonism, etc.);
3. Severe craniocerebral trauma, received craniocerebral surgery or deep brain stimulation treatment;
4. There are ferromagnetic implants in the body, such as cochlear implants, cardiac pacemakers, etc.
5. The person has a history of epilepsy, unexplained loss of consciousness, or are taking anticonvulsant drugs to treat epileptic seizures;
6. Diagnosed with a neuropsychiatric disorder other than PD
7. Have a history of drug abuse or drug use;
8. Participants in any clinical trial within the previous 6 month;
9. Pregnant/lactating women or subjects (including men) who have a birth plan within 6 months;
10. Other conditions deemed unsuitable for inclusion by the investigator.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Real rTMS group; Participants will receive active transcranial magnetic stimulation (TMS) daily for 1 week.	Other: transcranial magnetic stimulation; The stimulations were performed by MagStim Rapid2.
Placebo Comparator: Sham rTMS group; Participants will receive sham transcranial magnetic stimulation (TMS) daily for 1 week	Other: transcranial magnetic stimulation; The stimulations were performed by MagStim Rapid2.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Movement Disorder Society- Unified Parkinson's Disease Rating Scale III scores	This is an very common clinical motor estimating scale with 18 items and 140' in total. Higher scores indicate worse symptoms.	baseline; day 8; week 5;week 9

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hoehn-Yahr(H-Y) scale	H-Y scale is a standardized instrument used to evaluate the severity of Parkinson's disease. It employs a scoring system that ranges from 1 to 5, with higher scores indicating greater severity of clinical symptoms and a corresponding decline in quality of life. The assessment criteria primarily consider the number of limbs affected, the presence of balance disturbances, and the extent of functional impairment in daily living activities. This scale is valued for its simplicity and practicality, making it a prevalent tool in clinical trials for evaluating Parkinson's disease symptoms.	baseline; day 8; week 5;week 9
The timed up and go test (TUG)	TUG measures in seconds how long it takes the subject to rise from the chair, walk 3 meters, turn around, walk back to the chair, and sit down. The test is often used to assess walking and balance in older adults. This also applies to evaluating the severity of walking and balance symptoms in patients with Parkinson's disease.	baseline; day 8; week 5;week 9
20 meters walking	The 20-meter walking test measured the time it took for the subject to turn, continue to walk to the original place and turn back after walking from the upright position for 10m in seconds, and recorded the total number of steps. The test is also used to assess walking and balance in people with Parkinson's disease, but the distance is longer and more stable. Both tests were recorded on video with the patient's consent.	baseline; day 8; week 5;week 9
Non-motor symptom scale（NMSS）	NMSS is a validated assessment tool for non-motor symptoms in patients with PD. The scale consists of nine domains, each carrying a separate domain score, with higher scores indicating more severe symptoms for that domain. The score for each domain is derived by multiplying the severity and frequency ratings on a scale of 0-4. The total NMSS score is the sum of the nine field scores.	baseline; day 8; week 5;week 9
Clinical Global Impression（CGI）	CGI is used to evaluate the clinical treatment effect and is conducted by uniformly trained evaluators. The scale consists of three parts: severity of illness (SI), global improvement (GI) and efficacy index (EI). When evaluating SI, it is necessary to evaluate the severity of the patient's disease according to the relevant experience of patients with the same diagnosis in the past. When evaluating GI, the evaluator should compare the current condition of the patient with that at the time of enrollment to evaluate the treatment effect of the patient. Both SI and GI are evaluated on a scale of 0-7. Evaluation of EI includes two aspects, namely efficacy and side effects caused by treatment. Both were rated on a scale of 1-4. EI= efficacy score/side effect score. This scale integrates the severity of the patient's disease and the effect of treatment, which is helpful for following up the patient's condition changes.	baseline; day 8; week 5;week 9
Parkinson's Disease questionnaire-39 items（PDQ-39）	PDQ-39 is a self-rating scale for clinical evaluation of the quality of life of patients with Parkinson's disease, which consists of 8 dimensions and 39 items. The rating ranges from 0 to 4. The PDQ-39 total score is the sum of the 39 project scores.	baseline; day 8; week 5;week 9
Hamilton Depression Scale-17（HAMD-17）	HAMD-17 is commonly used in clinical trials to assess the severity of depression and is the gold standard for diagnosing depression. The scale was used to assess the depressive symptoms of patients through conversation and observation by uniformly trained evaluators, including 17 items, scoring on a 0-4 scale. If the total score is <7, there is no depression; A score between 7 and 17 indicates mild depression. A score between 18 and 24 indicates moderate depression; If the total score is more than 24, it indicates major depression.	baseline; day 8; week 5;week 9
Hamilton Anxiety Scale（HAMA）	HAMA is a tool commonly used to diagnose anxiety disorders. The evaluators with standardized training evaluated the anxiety symptoms of the patients by way of conversation and observation, which were mainly divided into physical anxiety and mental anxiety, with a total of 14 sub-items, the score range was 0-4, and the sum of the scores of each sub-item was the total score of the scale. If the total score is more than 29, it may be severe anxiety; Over 21 points, there must be significant anxiety; If more than 14 points, definitely have anxiety; More than 7 points, may have anxiety; Less than 7, no anxiety.	baseline; day 8; week 5;week 9
Pittsburgh sleep quality index（PSQI）	PSQI was used to evaluate the sleep quality of patients with sleep disorders and general people in the past month. The scale consists of 4 fill-in-the-blank questions and 5 multiple choice questions, and the fifth multiple choice question includes 10 multiple choice questions, for a total of 18 questions. The questions assessed patients' sleep quality from seven factors, including: subjective sleep quality, time to fall asleep, sleep duration, habitual sleep efficiency, sleep disorders, hypnotic medications, and daytime function. The total score of the scale is the sum of the 7 factor scores. The total score ranges from 0 to 21, with higher scores indicating poorer sleep quality.	baseline; day 8; week 5;week 9
Movement Disorder Society- Unified Parkinson's Disease Rating Scale Ⅰ scores	MDS-UPDRS I is used to evaluate the daily life non-motor symptom experience of patients with Parkinson's disease. It includes 13 items with a total score of 52 points. Higher scores indicate worse symptoms.	baseline; day 8; week 5;week 9
Movement Disorder Society- Unified Parkinson's Disease Rating Scale Ⅱ scores	MDS-UPDRS II is used to evaluate patients' experience of daily life motor symptoms, such as speech function, eating ability, daily living ability (eating, dressing, hygiene), tremor, walking, etc. It includes 13 items with a total score of 52 points. Higher scores indicate worse symptoms.	baseline; day 8; week 5;week 9
Movement Disorder Society- Unified Parkinson's Disease Rating Scale Ⅳ scores	The MDS-UPDRS IV questionnaire assesses the severity of two motor complications in patients: dyskinesias and motor fluctuations, combined with previously known and objective information. It includes 6 items with a total score of 24 points. Higher scores indicate worse symptoms.	baseline; day 8; week 5;week 9
Mini-Mental State Examination（MMSE）	MMSE is a widely utilized assessment tool in both clinical practice and scientific research for the evaluation of cognitive function and mental status. This scale measures several cognitive domains, including orientation, attention and calculation, delayed recall, verbal function, and visual-spatial abilities. The total score on the MMSE ranges from 0 to 30, with higher scores indicating better cognitive performance. Typically, a score below 24 is indicative of potential cognitive impairment.	baseline; day 8; week 5;week 9

Collaborators and Investigators

• Sponsor: Anhui Medical University
• Investigators: Principal Investigator: Panpan Hu, M.D., The First Affiliated Hospital of Anhui Medical University

Study record dates

Study Major Dates

• Study Start (Actual): December 6, 2024
• Primary Completion (Estimated): December 31, 2026
• Study Completion (Estimated): December 31, 2028

Study Registration Dates

• First Submitted: April 22, 2024
• First Submitted That Met QC Criteria: April 22, 2024
• First Posted (Actual): April 25, 2024

Study Record Updates

• Last Update Posted (Actual): June 17, 2025
• Last Update Submitted That Met QC Criteria: June 14, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Keywords: Parkinson Disease; supplementary motor area; transcranial magenetic stimualtion
• Additional Relevant MeSH Terms: Synucleinopathies; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurodegenerative Diseases; Movement Disorders; Parkinsonian Disorders; Basal Ganglia Diseases; Parkinson Disease
• Other Study ID Numbers: AMU-PD-multicenter

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No