A novel approach to the management of levodopa-induced dyskinesia using deep transcranial magnetic stimulation: A...

Levodopa-induced dyskinesia remains one of the most prevalent and disabling complications in patients with Parkinson's disease receiving long-term levodopa therapy. Although levodopa-induced dyskinesia can substantially impair the quality of life, therapeutic strategies are often limited to levodopa dose adjustment, amantadine, or deep brain stimulation. These treatment options may be ineffective, poorly tolerated, or declined by some patients. We applied low-frequency deep repetitive transcranial magnetic stimulation over the supplementary motor area in two patients with Parkinson's disease and clinically significant levodopa-induced dyskinesia who had limited conventional treatment options. Both patients completed a 2-week protocol without medication changes and demonstrated short-term reductions in dyskinesia severity, as assessed using the Unified Dyskinesia Rating Scale and motor-complication measures. No serious adverse events occurred. These observations suggest that supplementary motor area-targeted deep repetitive transcranial magnetic stimulation is a feasible noninvasive neuromodulation approach for selected patients with levodopa-induced dyskinesia. However, this is a two-patient case report without sham stimulation or extended follow-up; therefore, the findings should be interpreted as preliminary and hypothesis-generating. Larger controlled studies with objective outcome measures and longer follow-up are needed to determine the efficacy, durability, and optimal stimulation parameters.