{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T03:17:56Z","timestamp":1787627876661,"version":"build-2736575974"},"reference-count":49,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Neurorehabil Neural Repair"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Axial symptoms in Parkinson\u2019s disease (PD) often respond poorly to pharmacological treatment. We evaluated whether combining repetitive transcranial magnetic stimulation (rTMS) and repetitive spinal magnetic stimulation (rSMS) is more effective than rTMS alone in improving axial and other motor disabilities in PD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 42 PD patients with axial symptoms were randomly allocated to 2 experimental intervention groups: Group I received active rTMS\u2009+\u2009active rSMS (2000 pulses; 20\u2009Hz; 80% resting motor threshold for each motor area \u201cM1\u201d\u2009+\u20091500 pulses rSMS 10\u2009Hz, at 50% of maximal stimulator output). Group II received active rTMS\u2009+\u2009sham rSMS with the same number of pulses. Both groups received 10 sessions (5 consecutive days\/week for 2\u2009weeks). Assessments using Freezing of Gait Questionnaire, walking speed, Movement Disorder Society-Sponsored Revision of the Unified Parkinson\u2019s Disease Rating Scale (MDS-UPDRS) parts II and III, and Parkinson\u2019s Disease Questionaire-39 (PDQ-39) were performed at baseline (T0), end of sessions (T1), and 1\u2009month later (T2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At T0, Group II showed higher walking speed. At T1 and T2, Group I demonstrated significantly greater improvements in MDS-UPDRS parts II, III, and sub-items of part III. Group I showed stronger improvement in TUG-T and average fast velocity immediately post-intervention, but this effect diminished after 1\u2009month. PDQ-39 scores for leisure activity and walking problems were significantly higher in group I.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings indicate that combining rTMS and rSMS for 10 sessions is more effective than rTMS alone in managing PD\u2019s motor and axial symptoms. The effect size of the outcome is large enough to be of significance in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration:<\/jats:title>\n                    <jats:p>The study was registered prospectively on 26\/12\/2021 at the clinicaltrial.gov website with the registration ID: NCT05271513, https:\/\/clinicaltrials.gov\/study\/NCT05271513 .<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15459683241300547","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T04:54:18Z","timestamp":1733892858000},"page":"126-137","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["In PD, Non-Invasive Trans-Spinal Magnetic Stimulation Enhances the Effect of Transcranial Magnetic Stimulation on Axial Motor Symptoms: A Double-Blind Randomized Clinical Trial"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5679-9833","authenticated-orcid":false,"given":"Eman M.","family":"Khedr","sequence":"first","affiliation":[{"name":"Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nourelhoda A.","family":"Haridy","sequence":"additional","affiliation":[{"name":"Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad A.","family":"Korayem","sequence":"additional","affiliation":[{"name":"Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Mamdouh","family":"Tawfik","sequence":"additional","affiliation":[{"name":"Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A.","family":"Hamed","sequence":"additional","affiliation":[{"name":"Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,12,11]]},"reference":[{"key":"bibr1-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2018.03.009"},{"key":"bibr2-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2014.252"},{"key":"bibr3-15459683241300547","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2012.00066"},{"key":"bibr4-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1002\/mds.21460"},{"key":"bibr5-15459683241300547","doi-asserted-by":"publisher","DOI":"10.2176\/nmc.52.470"},{"key":"bibr6-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2011.07.015"},{"key":"bibr7-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1002\/mds.26850"},{"key":"bibr8-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1093\/bjaed\/mkv072"},{"key":"bibr9-15459683241300547","doi-asserted-by":"publisher","DOI":"10.3233\/JPD-223284"},{"key":"bibr10-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2019.6588"},{"key":"bibr11-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.10.001"},{"key":"bibr12-15459683241300547","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-022-01213-y"},{"key":"bibr13-15459683241300547","author":"Clarke C","year":"2016","journal-title":"UK Parkinson\u2019s Disease Society Brain Bank Diagnostic Criteria. 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