AUTHOR=Pan Jing , Mi Tao-Mian , Ma Jing-Hong , Sun Hong , Chan Piu 

TITLE=High-Frequency Repetitive Transcranial Magnetic Stimulation Over the Left Dorsolateral Prefrontal Cortex Shortly Alleviates Fatigue in Patients With Multiple System Atrophy: A Randomized Controlled Trial

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.755352

DOI=10.3389/fneur.2021.755352

ISSN=1664-2295

ABSTRACT=Background: Fatigue is a common symptom in patients with Multiple system atrophy, but effective treatments remain elusive. The present study aims to investigate whether high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex could relieve fatigue in patients with Multiple system atrophy. 
Methods: This is a single-center, randomized and double-blind trial. Twenty-two patients with Multiple system atrophy and fatigue were randomly allocated to receive 10 sessions of either active (N=11) or sham (N=11) 10Hz rTMS over the left dorsolateral prefrontal cortex. The participants were assessed at baseline (T0), after the last session of treatment (T1), and at 2-week (T2) and 4-week (T3) follow-up timepoints. The primary outcomes were Fatigue Severity Scale-9 (FSS-9) scores, with Unified Multiple System Atrophy Rating Scale (UMSARS), 17-item Hamilton Depression Scale (HAMD-17), and Hamilton Anxiety Scale (HAMA) as secondary outcomes. 
Results: Two-way repeated ANOVAs revealed significant group × time interactions for FSS-9 scores (p < 0.001), HAMD-17 scores (p = 0.01) , HAMA scores (p = 0.01) and UMRSA part II (p=0.05). Post hoc analyses showed that compared to T0, the active group exhibited remarkable improvements in FSS-9 scores, HAMD-17, HAMA and UMRSA part II at T1 and T2, but not at T3. No significant improvement was found in the sham group. 
Conclusion: High-frequency rTMS over the left dorsolateral prefrontal cortex could provide short-term improvements for alleviating fatigue in patients with Multiple system atrophy, but the beneficial effects last no more than 4 weeks.