Transcranial Pulse Stimulation in Parkinson's Disease: A Systematic Review.
Gabrielly Santos Pereira, Gustavo Henrique de Mello Rosa, Palmerindo Antônio Tavares de Mendonça Neto et al.
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In 30 seconds
This systematic review assessed clinical, neurophysiological, imaging, and safety outcomes of transcranial pulse stimulation (TPS) in adults with idiopathic Parkinson’s disease. It included four studies involving 80 participants: two sham-controlled studies, an open-label pilot, and a retrospective uncontrolled study. Although uncontrolled studies reported improvements across several symptom domains, a randomized double-blind crossover trial found no superiority of active TPS over sham for global motor scores (MDS-UPDRS Part III). Selected findings included improved left-hand dexterity and immediate tremor reduction, but sustained benefits remain uncertain. No serious treatment-related adverse events were reported; evidence certainty ranged from moderate to very low.
Key findings
- Four studies involving 80 participants were included; evidence certainty ranged from moderate to very low.
- A randomized double-blind crossover trial found no active-TPS superiority over sham for global motor scores (MDS-UPDRS Part III).
- Improvement in left-hand manual dexterity persisted for one month and was accompanied by sensorimotor activation and white-matter changes.
- No serious treatment-related adverse events were reported; sustained superiority for tremor reduction remained uncertain.
Why it matters
The review distinguishes promising signals in selected motor outcomes from evidence of overall clinical efficacy. For clinicians, this means TPS should be viewed as investigational: reported changes in dexterity, tremor, and neural measures do not yet establish broad or durable benefit. The findings also highlight the need to interpret uncontrolled improvements cautiously when sham-controlled results are not consistently positive.
What to keep in mind
Only four studies with 80 participants were included, and methodological heterogeneity required narrative synthesis. Evidence certainty ranged from moderate to very low, and sustained benefits remain uncertain.