Efficacy of cerebellar transcranial magnetic stimulation in spinocerebellar ataxia type 3: A randomized controlled trial

Spinocerebellar ataxia type 3 (SCA3) is the most common subtype of SCA without effective treatment. This study aimed to evaluate the comparative efficacy of low-frequency repetitive transcranial magnetic stimulation (rTMS) and intermittent Theta Burst Stimulation (iTBS) in a larger cohort of SCA3 patients. One hundred and twenty patients with SCA3 were randomly selected to receive 1Hz rTMS, iTBS or sham. All patients were assessed at baseline and after all sessions. Primary outcomes included the Scale for the Assessment and Rating of Ataxia (SARA) and the International Cooperative Ataxia Rating Scale (ICARS). Secondary outcomes included 10-meter walking test (10MWT), nine-hole peg test (9-HPT), and PATA Rate Test (PRT). This study revealed that 1Hz rTMS and iTBS outperformed sham in reducing the SARA and ICARS scores in SCA3 patients, but with no difference between 1Hz rTMS and iTBS. Furthermore, iTBS decreased 9-HPT scores when using a non-dominant hand. Additionally, we found that symptom severity variance of patients did not influence the effect of rTMS on the clinical impression. No severe adverse events were recorded in this study. The study concluded that 1Hz rTMS and iTBS interventions targeting the cerebellum are effective and safe in patients with SCA3.