Clinical and neurophysiological effects of bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson's disease: a randomized, four-arm controlled trial.
Juan Pablo Romero, Marcos Moreno-Verdú, Aida Arroyo-Ferrer and 5 others
PMID 39103947WHAT IT FOUND
Combining brain stimulation with neurofeedback improved Parkinson's motor symptoms more than either alone.
However, neither treatment changed walking speed, balance, or finger tapping speed. The effect on quality of life was positive but based on a small, unblinded sample.
Key findings
01The combination of rTMS and neurofeedback produced the largest reduction in motor symptom severity scores compared to no intervention.
02There were no significant differences between any treatment group and the control group for functional mobility (Timed Up and Go) or postural stability.
03All three active treatment groups reported improvements in health-related quality of life, with the combined group showing the largest effect.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The sample size was very small (10 per group), reducing statistical power. There was no sham or placebo control for either rTMS or neurofeedback, so placebo effects cannot be ruled out. The follow-up period was short (16 days), so long-term effects are unknown. Participants were already on optimized medication and had mild disease (Hoehn & Yahr I-III), limiting generalizability to more advanced stages.
Declared interests
The study was funded by the Spanish Ministry of Economy and Competitiveness and the Ministry of Science and Innovation. The authors declared no competing interests.
The easy way to misread this
Do not assume that combining treatments yields clinically meaningful functional gains. While motor scores improved, key functional outcomes like balance and walking speed did not change significantly compared to doing nothing, and the lack of sham controls makes it difficult to separate true physiological effects from placebo.