January 2022

Effects of High-Frequency Repetitive Transcranial Magnetic Stimulation on Upper Limb Dystonia in Patients With Wilson’s Disease: A Randomized Controlled Trial

Authors: Wenjie Hao 1, Taohua Wei 2, Wenming Yang 2, Yue Yang 3, Ting Cheng 4, Xiang Li 2, Wei Dong 2, Hailin Jiang 3, Nannan Qian 3, Han Wang 2, Meixia Wang 2


  1. Department of Graduate, Anhui University of Chinese Medicine, Hefei, China
  2. Department of Neurology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
  3. Key Laboratory of Xin’an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, China
  4. Department of Clinical Medicine, Clinical Medicine College of Anhui Medical University, Hefei, China

Journal: Frontiers in Neurology - December 2021, Volume 12, Article no. 783365 (DOI: 10.3389/fneur.2021.783365)

Background: Upper limb dystonia is a frequent complication of Wilson’s disease (WD). It can lead to poor quality of life and disability. Currently, no effective treatment for it exists. Therefore, we carried out a clinical trial to determine whether high frequency repetitive transcranial magnetic stimulation (rTMS) on the primary motor cortex alleviates upper limb dystonia in WD patients.

Methods: This study was a single-center, double-blind, randomized clinical study, included 60 WD patients with upper limb dystonia from a research base of WD in Hefei, China. Participants were randomly divided into a treatment group (TG) and a control group (CG). The TG received rTMS at 10 Hz, while the CG received sham stimulation for 7 consecutive days. Participants were assessed at baseline, after the seventh treatment session, and at 2 and 4 weeks after the seventh treatment session. The primary outcomes included patients’ objective muscle tension and stiffness as measured with the MyotonPRO device. The secondary results were scores on clinical scales assessing muscle spasm and motor symptoms, which included the Modified Ashworth Scale (MAS), Unified Wilson’s Disease Rating Scale (UWDRS), Burke Fahn Marsden Scale (BFM), and the Activities of Daily Living (ADL) scale.

Results: The analysis revealed that after 10 Hz rTMS, muscle tension (P < 0.01) and stiffness (P < 0.01) as measured by the MyotonPRO device decreased significantly in the TG compared to the CG. Moreover, clinically relevant scale scores, including the MAS (P < 0.01), UWDRS (P < 0.01), BFM (P < 0.01), and ADL (P < 0.01) were also significantly reduced.

Conclusion: High-frequency rTMS over the primary motor cortex may be an effective complementary and alternative therapy to alleviating upper limb dystonia in WD patients.


Keywords: repetitive transcranial magnetic stimulation, Wilson’s disease, upper limb myotonia, primary motor cortex, randomized controlled trial

Our results suggest that 10 Hz rTMS can reduce the symptoms of biceps dystonia in WD patients in a short period of time and thereby improve their quality of life. Thus, our protocol can be used as a complementary or replacement therapy to relieve muscle spasm in WD patients.