Cerebello-cortical inhibition underlies the effects of cerebellar magnetic stimulation on spinocerebellar ataxia type 3: A randomized controlled trial

作者：Yuchao Chen, Jie Zhou, Zhouyao Hu, Yi Jin, Bolin Tan, Ying Wang, Yi Sha, Qiusi Cai, Yijun Chen, Yuchen Wang, Mingyue Qu, Zhiyuan You, Yimeng Shao, Yingying Zhu, Zhongming Gao, Yang Bai, Guilin Meng, Pengfei Xu, Dongsheng Xu, Paul B. Fitzgerald, Xianwei Che · 发表于：Brain stimulation · 年份：2025 · DOI：10.1016/j.brs.2025.09.020 · 被引用次数：5 · 研究领域：Transcranial Magnetic Stimulation Studies、Genetic Neurodegenerative Diseases、Vestibular and auditory disorders

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) over the cerebellum has shown therapeutic potential for spinocerebellar ataxia type 3 (SCA3). However, the underlying electrophysiological mechanisms remain unclear. Here, we aimed to utilize single-pulse TMS combined with electroencephalography co-registration (TMS-EEG) to probe cerebellar projections underlying the effects of rTMS in SCA3 patients. METHODS: A group of 38 SCA3 patients and 35 healthy controls underwent baseline TMS-EEG to assess cerebellar projections. Patients were evaluated using the International Cooperative Ataxia Rating Scale (ICARS) and then randomized to receive either a 3-week course of active intermittent theta burst stimulation (iTBS) or sham iTBS applied to the cerebellum. ICARS assessments were then performed at post-treatment and 3-month follow-up, with additional TMS-EEG performed post-treatment. RESULTS: ICARS scores were improved by iTBS treatment than the Sham stimulation at post-treatment (2.67 [95 %CI, 0.53-4.81]; p = 0.016) and 3-month follow-up (4.11 [95 %CI, 1.02-7.20]; p = 0.011). iTBS restored cerebello-cortical inhibition over the contralateral motor cortex as reflected by enhanced N45 amplitude (1.31 [95 %CI, 0.08-2.53]; p = 0.038), which covaried with better clinical improvement (p = 0.005). iTBS also reorganized beta band oscillation, that potentially underlies the cerebello-cortical inhibition in SCA3 individuals. At the source level, cerebellar rTMS normalized the i...