Role of Accelerated Continuous Theta Burst Stimulation in Hand Dystonia: From Acute Phase to Maintenance Treatment

Dystonia presents as a complex neurological disorder that can be challenging to manage, often impacting specific parts of the body and involving dysfunction in the cortico-subcortical loop, particularly the basal ganglia. Emerging evidence points to heightened motor cortex excitability, hyperplasticity of the sensorimotor cortex, and abnormal sensorimotor integration as pivotal factors contributing to dystonia. Consistent research findings underscore the significance of contralateral motor cortex hyper-excitability in the progression of focal dystonia. Therefore, neuromodulation techniques like repetitive transcranial magnetic stimulation hold promise in modulating focal cortical activity and addressing dystonia. This case study details the treatment of a 70-year-old male patient with progressive left upper limb dystonia and associated pain. The patient received all recommended treatments for hand dystonia, including botulinum toxin injections. Accelerated continuous theta burst stimulation (acTBS) was used to mitigate the challenges posed by the condition. This case underscores the potential advantages of neuromodulation techniques, such as acTBS and transcutaneous electrical nerve stimulation (TENS), in managing upper limb dystonia and its related pain symptoms. It highlights the promise of non-invasive interventions in enhancing function and quality of life for individuals with similar conditions.